DECOMPRESSIVE CRANIECTOMY IN MALIGNANT STROKE: COMPARING OUTCOMES AND IDENTIFYING MORTALITY PREDICTORS ACROSS ISCHAEMIC, HAEMORRHAGIC, AND VENOUS AETIOLOGIES

Abstract

Background and Aims: Prospective trials and registries have established the positive benefit of decompressive craniectomy (DC) in large cohorts of acute ischaemic stroke (AIS), intracerebral haemorrhage (ICH) and cerebral venous sinus thrombosis (CVST). This study directly compares post-operative functional outcomes and identifies predictors of mortality following decompressive craniectomy across AIS, ICH, CVST in a single cohort. Methodology: This ambispective study at a university teaching hospital included patients who underwent decompressive craniectomy from 2020 to 2024. Clinical characteristics including level of consciousness, stroke severity along with laboratory and radiological data were obtained. Outcome was measured using modified Rankin score during follow-up. Results: Among the 59 patients who underwent DC, 29 had acute ischaemic stroke, 14 had ICH and 16 had CVST. CVST patients were younger (36.25 ± 12.24 years) than AIS (53.72 ± 14.36) and ICH (56.36 ± 13.65) patients (p = 0.0005). Favourable outcome was achieved in 43.8% of CVST patients versus 13.8% AIS and 7.1% ICH (p = 0.022). Mortality was 58.6%, 64.3%, and 25.0% in AIS, ICH, and CVST respectively (p = 0.05). Older age, lower Glasgow coma score, high NIHSS, dominant hemisphere involvement, and postoperative sepsis were significant predictors of mortality. Conclusion: Large strokes due to CVST were associated with substantially better functional recovery and lower mortality after DC, while AIS and ICH had broadly comparable and uniformly poor post-surgical prognoses. Patients with older age, impaired consciousness, high NIHSS, dominant hemisphere involvement, and postoperative sepsis had increased mortality.