Decompressive craniectomy in subarachnoid hemorrhage compared to other etiologies: An institutional experience of 11 years.

Introduction: Decompressive craniectomy (DC) is a last-tier procedure to lower intracranial pressure in otherwise fatal brain injuries. DC significantly reduces mortality following traumatic brain injury (TBI) and ischemic stroke, but benefits in subarachnoid hemorrhage (SAH) are less clear. Research question: We compared the mortality and functional outcomes in patients who underwent DC after SAH with those who underwent DC following TBI or ischemic stroke. Materials and methods: All DC procedures performed in the Oulu University Hospital between January 2009 and December 2019 were retrospectively identified. Mortality and functional outcomes were assessed during a median follow-up of 20.7 months. Extended Glasgow Outcome Scale scores ≥5 were considered favorable. Results: One hundred twenty-four DCs were conducted to patients aged a median of 40 years (SD 16), of whom 88 (71%) were male. Fifty-eight (47%) DCs were due to TBI and 66 (53%) due to stroke. Of the strokes, 41 (62%) were ischemic and 21 (32%) SAH.In multivariate models, the rates of unfavorable outcome were 48% in TBI, 78% in ischemic stroke (OR 2.73, 95% CI 0.70-10.64) and 86% in SAH (OR 3.15, 95%CI 0.67-14.77). Mortality rates were 22% in TBI, 17% in ischemic stroke (OR 0.50, 95%CI 0.11-2.31) and 33% in SAH (OR 0.97, 95%CI 0.24-3.99). Discussion and conclusion: Favorable outcomes were more common in TBI compared to stroke in univariate but not in multivariate analysis. There was no statistically significant difference in the rates of favorable outcomes between SAH and ischemic stroke.