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Updated: Jun 15, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Decompressive craniectomy for patients with severe non-traumatic brain injury: a retrospective cohort study
Louise Hitchings1, Anthony Delaney
1Intensive Care Unit, Sydney Children's Hospital, Sydney, NSW. lmhitch@yahoo.com
Insights
Decompressive craniectomy (DC) can save lives from acute intracranial hypertension but may lead to severe disability. Its role in non-trauma brain injury remains uncertain.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Acute intracranial hypertension from non-trauma brain insults poses significant mortality risks.
- Decompressive craniectomy (DC) is a neurosurgical intervention to manage elevated intracranial pressure.
- The utilization and outcomes of DC for non-trauma indications require further elucidation.
Purpose of the Study:
- To describe the current utilization and outcomes of decompressive craniectomy (DC) for acute non-trauma-related indications.
- To evaluate the effectiveness and complications associated with DC in this patient population.
Main Methods:
- Retrospective cohort study of neurosurgical patients undergoing DC for non-trauma brain insults.
- Data collected from a tertiary referral neurosurgical intensive care unit (January 2001 to June 2008).
- Analysis included patient demographics, treatments, DC indications/results, length of stay, and 6-month outcomes.
Main Results:
- 56 DC procedures were performed on 54 patients, with increasing annual utilization.
- DC significantly reduced intracranial pressure, but 10 patients died from uncontrollable hypertension.
- Overall 6-month mortality was 39%; survivors often had significant deficits, with rare complete recovery.
Conclusions:
- Decompressive craniectomy (DC) offers life-saving potential but can result in severely debilitated survivors.
- The definitive role of DC in managing non-trauma-related intracranial hypertension is not yet established.
- Further research is needed to optimize patient selection and management strategies for DC.
Objective:
To describe the current utilisation and outcomes for patients receiving decompressive craniectomy (DC) for acute non-trauma-related indications.
Design, Setting And Participants:
Retrospective cohort study of neurosurgical patients who underwent DC to relieve acute intracranial hypertension after a non-traumarelated brain insult. The study was based on data from medical records of a tertiary referral neurosurgical intensive care unit over the period January 2001 to June 2008.
Main Outcome Measures:
Patient demographics, treatments received, indication for and result of DC, length of stay, hospital outcomes and 6-month outcomes.
Results:
54 patients underwent 56 DC procedures during the study period. The number of DCs performed per year increased over this period. Although intracranial pressure was significantly reduced by the procedure, 10 patients later died of uncontrollable intracranial hypertension. The patients had long hospital stays and consumed significant health care resources. Among survivors, about two-thirds had a good outcome, although it was rare for patients to be free of any deficit or complaint at follow-up. Complications were frequent, but not associated with high mortality. Overall 6-month mortality was 39%.
Conclusions:
DC has the potential to save lives, but also the potential to leave survivors in a severely debilitated state. The place of DC in managing patients with severe intracranial hypertension due to non-trauma related causes is yet to be definitively established.
