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ArticleActa neurochirurgica2025

Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: can favorable outcome be achieved?

Teodor Svedung Wettervik, Alba Corell, Merete Sunila, Per Enblad, Fartein Velle, Peter Lindvall, Lars Kihlström Burenstam Linder, Bjartur Sæmundsson, Alexander Fletcher-Sandersjöö, Klas Holmgren

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Decompressive craniectomy in traumatic brain injury: insights from a 15-year multicentre cohort in Sweden.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Teodor Svedung WettervikDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden. teodor.svedung-wettervik@neuro.uu.se.
Alba CorellDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Merete SunilaDepartment of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Per EnbladDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Fartein VelleDepartment of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Peter LindvallDepartment of Clinical Science - Neurosciences, Umeå University, Umeå, Sweden.
Lars Kihlström Burenstam LinderDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Bjartur SæmundssonDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Alexander Fletcher-SandersjööDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Klas HolmgrenDepartment of Clinical Science - Neurosciences, Umeå University, Umeå, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDecompressive craniectomy (DC) is a last-tier treatment for managing refractory intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage (aSAH), though concerns persist about whether it primarily prolongs survival in a state of severe disability. This study investigated patient characteristics, surgical indications, complications, and outcomes following DC in aSAH.

methodsIn this Swedish, retrospective multi-center study, 123 aSAH patients treated with DC between 2008-2022 were included. Data collection included demographic details, aSAH characteristics, injury severity, DC indication, complications, and outcome at roughly six months post-DC (modified Rankin scale [mRS]) dichotomized as survival vs. mortality (0-5 vs. 6) and favorable vs. unfavorable (0-3 vs. 4-6).

resultsThe median age was 53 years and 66% were females. Two thirds presented with a WFNS grade 4-5 and 83% with a Fisher grade 4 hemorrhage. Most aneurysms were located at the middle cerebral artery (65%) and treated with clip ligation (59%). DC significantly reduced midline shift from 9 to 2 mm and obliteration rates of basal cisterns from 95 to 22% (p < 0.05). Reoperation for hematomas or extension of the DC were rare (< 5%). At follow-up, 20% were deceased, while 33% had recovered favorably. In univariate logistic regressions, younger age was associated with favorable outcome and reduced mortality. Other patient demographics, injury severity, and factors related to the DC surgery lacked association with outcome.

conclusionsaSAH patients treated with DC presented with severe primary brain injuries and signs of intracranial hypertension. DC resulted in radiological improvements regarding mass effect and a low rate of postoperative complications. Although the results were based on a selected population of aSAH patients, an encouraging rate of favorable outcome was found, particularly among younger patients. However, the absence of additional outcome predictors underscores the ongoing challenges in improving patient selection for DC in aSAH.

Indexed as

Decompressive CraniectomyIntracranial AneurysmIntracranial HypertensionSubarachnoid HemorrhageAdultAgedFemaleHumansMaleMiddle AgedPostoperative ComplicationsRetrospective StudiesSwedenTreatment OutcomeAneurysmal subarachnoid hemorrhageDecompressive craniectomyIntracranial pressureOutcomeThiopental

Identifiers

PMID40069502
PMCPMC11897068

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.