How I do it: supra-tentorial unilateral decompressive craniectomy.

Background: Decompressive craniectomy is a surgical way to treat intracranial hypertension, by removing a large flap of skull bone.

Method: We report the case of a 48 years old right-handed man presenting an acute ischaemic stroke of all the right sylvian artery area, with rapid clinic deterioration then coma. Severe intracranial hypertension was confirmed by transcranial Doppler. In emergency, we decided to perform a right-side decompressive craniectomy.

Conclusion: Six months later, he is in rehabilitation with "only" a left hemiplegia and a very good relational life. His modified Rankin score is 3. Decompressive craniectomy saved this patient's life, that is why we think this surgical technique must be explained and mastered.