In reply to "Ways to improve outcome of decompressive craniectomy: judicious utilization of microneurosurgical technique adjuncts"

We read with interest the article “Measurement of bone flap surface area and midline shift to predict overall survival after decompressive craniectomy ”. 1 Decompressive craniectomy is associated with multitude of therapeutic effects including enlargement of the intracranial volume , re-opening up of perimesencephalic cisterns, improvement of cerebral compliance, increase in cerebral blood flow and cerebral perfusion, improvement of cerebrovascular regulation and reduction in midline shift, and intracranial pressure . However, outcome of decompressive craniectomy depends on various factors i.e. age of patient, primary intracranial pathology, size of decompressive craniectomy, preoperative midline shift, preoperative rise in intracranial pressure level, co-morbid illness, neurological status, mass effect and still controversy exists regarding size of decompressive craniectomy, optimal patient group, timings and surgical technique.