The authors present the tactics and technique of the decompression craniotomy (DC). DC is one of the principal neurosurgical procedures in the treatment of intracranial hypertension. Early indication and perfect technical completion of the procedure are the prerequisites for achieving the anticipated decompressive effect . While indications of DC are frequently discussed in the scientific literature, the procedure's tactics and techinque is usually overlooked. The report mentions the DC development and significance from its historical perspective. Decompression craniotomy should be performed as a preventive procedure to prevent secondary brain damage. Four types of craniotomy are used in order to perform decompression: subtemporal, circular, bifrontal and hemispheral. The hemispheral DC best fulfills the essential requirement regarding the brain stem direct compression release. The technical aspect of the hemispheral decompression procedure is described further in the report. The authors discuss some technical aspects, which, provided they are followed, should prevent the surgical method from failure. Incorrect technical performance, especially insufficient extent of the decompression, along with its late indication, is the principal factor discrediting the idea of decompression craniotomy.

        Key words: decompression surgery – decompressive craniectomy – intracranial hypertension – cerebral edema