Decompressive craniectomy is a life-saving neurosurgical procedure designed to alleviate the effects of uncontrolled intracranial hypertension due to conditions like severe traumatic brain injury (TBI) and malignant cerebral edema following an ischemic stroke [1–3]. Time is critical; medical decisions must be made as soon as indications arise, and the procedure should be conducted as quickly as possible. By removing a section of the skull and opening the dura, decompressive craniectomy reduces intracranial pressure (ICP), prevents brain herniation, and enhances cerebral perfusion [1, 3]. The strongest indication for decompressive craniectomy is failure of maximal medical management to control elevated ICP, as persistent intracranial hypertension considerably heightens the risk of mortality and severe disability [3]. Although it remains controversial due to the potential for long-term morbidity, decompressive craniectomy has shown survival benefits, particularly in patients with malignant middle cerebral artery infarction and refractory posttraumatic intracranial hypertension [2, 3]. Ongoing trials are further refining patient selection criteria, optimal surgical techniques, and long-term outcomes to maximize the benefits of this intervention [1].