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Decompressive Craniectomy: Trial Evidence and Impact on Guidelines.
Conor S Gillespie1, Midhun Mohan2, Angelos Kolias3
1Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Neurosurgery Clinics of North America
|April 12, 2026
Summary
Decompressive craniectomy improves survival for traumatic brain injury, stroke, and hemorrhage. Appropriate use of this neurosurgical procedure is now indicated across these conditions based on recent evidence.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Neurology
Background:
- Decompressive craniectomy is a neurosurgical procedure debated for traumatic brain injury (TBI), ischemic stroke, and intracerebral hemorrhage.
- Initial studies suggested increased survival but also potential for higher morbidity.
Purpose of the Study:
- To review key clinical trials on decompressive craniectomy.
- To analyze the influence of trial findings on international treatment guidelines.
Main Methods:
- Review of pivotal randomized controlled trials and retrospective series.
- Analysis of subsequent updates to international clinical practice guidelines.
Main Results:
- Emerging evidence from new trials supports the indication of decompressive craniectomy.
- Appropriate application of the procedure is crucial for favorable outcomes in TBI, stroke, and hemorrhage.
Conclusions:
- Decompressive craniectomy is indicated for traumatic brain injury, ischemic stroke, and intracerebral hemorrhage when performed correctly.
- Published trial data has significantly shaped current international guidelines for neurosurgical interventions.
