Bilateral craniectomy in a woman comatose and decerebrate after a subarachnoid hemorrhage, resulted in normal mentation in 3 days. The dramatic recovery is unmatched in our experience. The rationale rested on clinicopathologic studies showing that in such cases brain swelling was the cause of death, the brain being otherwise intact. Emergency surgery to relieve the tamponade seemed reasonable. The question is whether the procedure has a role in those patients who fail to respond to current therapeutic measures. The arguments in favor, presented herein, are illustrated by three pathologic studies selected from our longtime experience.