# Efficacy of decompressive craniectomy: A retrospective case series study with 321 patients and an update on controversies

## TL;DR

This study examines the effectiveness of decompressive craniectomy in 321 patients and finds better outcomes for those with middle cerebral artery events.

## Contribution

The study provides new insights into the differential outcomes of decompressive craniectomy based on the underlying neurological condition.

## Key findings

- Patients with middle cerebral artery events had more favorable outcomes after decompressive craniectomy.
- Multivariate analysis showed group A (MCA events) was an independent factor for better Glasgow outcome scale scores.
- Traumatic brain injury was the most common indication for decompressive craniectomy in the study cohort.

## Abstract

Decompressive craniectomy (DC) is considered a cornerstone in the management of refractory intracranial hypertension. For decades, DC was known as an occasionally lifesaving procedure; however, it was associated with numerous severe complications. The present study is a single-center retrospective case series study on with 321 patients who underwent DC between January, 2010 and December, 2020. All patients were divided into four groups as follows: Group A included patients who suffered from a space-occupying middle cerebral artery (MCA) ischemic event; group B included individuals who developed intracerebral hemorrhage; group C included patients admitted for traumatic brain injury; and group D included patients with other neurosurgical entities that underwent DC, such as subarachnoid hemorrhage, tumors, brain abscess and cerebral ventricular sinus thrombosis events. The present study enrolled a total of 321 patients who underwent DC. Group A included 52 out of the 321 (16.1%) patients, group B included 51 (15.8%) patients, group C included 164 (51.0%) patients, and group D included 54 (16.8%) patients. Of the 321 patients, 235 (73.2%) were males, and the median age was 53.7 years. Multivariate analysis revealed that only the group A parameter was an independent factor associated with a Glasgow outcome scale score >2 during follow-up (P<0.05). On the whole, the results of the present study suggest that among patients who underwent DC with different neurological entities, those who had experienced MCA events had more favorable outcomes.