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Updated: Sep 25, 2025

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Decompressive Craniectomy for Stroke: Who, When, and How.

Gregory J Cannarsa1, J Marc Simard2

  • 1Department of Neurosurgery, University of Maryland Medical Center, 22 S Greene Street, S12D, Baltimore, MD 21201, USA.

Neurologic Clinics
|April 25, 2022
PubMed
Summary

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Early decompressive craniectomy significantly improves outcomes and reduces mortality in malignant cerebral edema patients. Surgical intervention benefits even older patients, though to a lesser extent.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Malignant cerebral edema following large hemispheric infarct is a severe condition with high morbidity.
  • Decompressive craniectomy is a recognized surgical intervention for this condition.

Purpose of the Study:

  • To review the evidence supporting decompressive craniectomy for malignant cerebral edema.
  • To discuss the procedure, its benefits, complications, and alternatives.

Main Methods:

  • Review of major randomized trials over the past two decades.
  • Inclusion of procedural details and complication data.
  • Survey of recent literature on alternative treatments.

Main Results:

Keywords:
Decompressive craniectomyGlibenclamideIschemic strokeLarge hemispheric infarctMalignant cerebral edema

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  • Early decompressive craniectomy (<48 hours) improves functional outcomes (mRS 0-3) and reduces mortality.
  • Surgical intervention shows persistent benefit in patients over 60 years, albeit with a lesser magnitude.
  • A summary table of key trials is provided.

    • Conclusions:

    • Decompressive craniectomy is a beneficial treatment for malignant cerebral edema.
    • The timing of surgery and patient age are important factors influencing outcomes.
    • Ongoing research explores alternative and complementary therapies.