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Decompressive craniectomy for spontaneous supratentorial intracerebral hemorrhage: a systematic review and

Renan M DA Costa1, Ugo F Filho1, Kíssia S Barbosa1

  • 1Health Science Center, Department of Morphology, Federal University of Paraíba, João Pessoa, Brazil.

Journal of Neurosurgical Sciences
|December 9, 2025
PubMed

Insights

Decompressive craniectomy (DC) significantly reduces mortality for spontaneous supratentorial intracerebral hemorrhage (SSICH) patients compared to best medical treatment (BMT). This treatment did not impact infection rates, highlighting its potential as a life-saving intervention for SSICH.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Spontaneous supratentorial intracerebral hemorrhage (SSICH) presents a significant clinical challenge due to high morbidity and mortality.
  • Decompressive craniectomy (DC) is a potential intervention to mitigate intracranial pressure and secondary brain injury in SSICH.
  • The efficacy of DC in SSICH management remains incompletely understood, necessitating further investigation.

Purpose of the Study:

  • To systematically review and meta-analyze existing evidence on the impact of DC on clinical outcomes in SSICH patients.
  • To evaluate the effectiveness of DC, alone or with best medical treatment (BMT), versus BMT alone in managing SSICH.

Main Methods:

  • A comprehensive search of PubMed, Embase, and Cochrane databases was performed.
  • Included studies involved adult SSICH patients, comparing DC (with or without BMT) against BMT alone.
  • Six studies (one RCT, five observational) involving 492 patients were analyzed for mortality and infection rates.

Main Results:

  • Decompressive craniectomy (DC) demonstrated a statistically significant reduction in mortality across multiple time points (30 days, 3 months, 6 months, 12 months) compared to best medical treatment (BMT) alone.
  • Subgroup analyses confirmed the significant survival benefit of DC in SSICH patients.
  • No significant differences were observed in the incidence of overall infections, pneumonia, or urinary tract infections between the DC and BMT groups.

Conclusions:

  • Decompressive craniectomy (DC) is associated with reduced mortality in patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) when compared to best medical treatment (BMT).
  • The choice between DC and BMT does not appear to influence the risk of developing pneumonia or urinary tract infections.
  • Further high-quality randomized controlled trials (RCTs) are warranted to solidify these findings and guide clinical practice.
Abstract

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