A common cause requiring invasive brain surgery is fatal pressure from swelling-induced deformation. Neurosurgeons try to relieve pressure using decompressivecraniectomies, which involves cutting into the skull to allow the brain to ‘bulge out’. Even though this surgery has been happening for over a century, surgeons have little else other than previous experiences to help reduce the risk of post-surgical complications such as severe disabilities; even slight changes in mechanical conditions can have devastating results on the brain. During decompressive craniectomies, nerve fibres in the brain, known as axons, stretch, and run the risk of shearing, making this procedure a ‘last resort’ for surgeons. Precise criteria are unavailable to surgeons for determining factors such as timing, as well as the optimal location and size of the skull opening.

New solutions developed by researchers at Stevens Institute of Technology, Stanford University, Oxford University, and University of Exeter tackle this problem through a Finite Element (FE) model of the brain created in Synopsys Simpleware software [1, 2]. The model is used to simulate craniectomy procedures under different conditions. The use of these methods gives neurosurgeons insight into extreme tissue kinematics, enabling them to plan the shape and position of the craniectomy.