Does decompressive craniectomy improve functional outcomes in severe traumatic brain injury (TBI) and refractory intracranial hypertension? The DECRA trial explored the role of early decompressive craniectomy in patients with severe diffuse TBI and refractory intracranial hypertension. The study compared outcomes between patients receiving decompressive craniectomy versus standard care. Despite effectively lowering intracranial pressure, the trial found that decompressive craniectomy was associated with worse functional outcomes at 6 months, as measured by the Extended Glasgow Outcome Scale. These findings suggested that while the procedure reduces intracranial pressure, it may not improve—and could even worsen—long-term recovery in this patient population.