Clinical Profile and Predictors of Functional Outcome After Decompressive Craniectomy Across Major Stroke Subtypes: A Retrospective Cohort Study

Background: Decompressive craniectomy is used in severe stroke with malignant cerebral oedema or mass effect, but long-term functional outcome varies considerably. Material and Methods: This retrospective cohort study included 287 patients undergoing decompressive craniectomy for ischemic stroke, intracerebral haemorrhage, or cerebral venous sinus thrombosis between 2019 and 2024. Clinical, radiological, perioperative, and follow-up data were analysed. Poor 1-year outcome was defined as modified Rankin Scale (mRS) 5–6. Multivariable logistic regression identified independent baseline predictors. Results: Ischemic stroke accounted for 62.4% of cases, ICH for 30.0%, and CVST for 7.7%. In-hospital mortality was 15.3%. At 1 year, 149/264 (56.4%) had favourable outcome and 115 (43.6%) had poor outcome. Older age (aOR 1.92 per 10 years), higher admission NIHSS (aOR 1.63 per 5 points), and lower GCS (aOR 1.29 per point decrease) independently predicted poor outcome. Conclusion: Long-term outcome after decompressive craniectomy was more strongly related to age and neurological severity than to stroke subtype or surgical timing.

Keywords: Decompressive craniectomy; Stroke; Functional outcome; Modified Rankin Scale; Prognostic factors.