Outcome of Decompressive Craniectomy Surgery: A Study at King Khalid Hospital, Hail

Background: Decompressive craniectomy (DC) is a life-saving surgical intervention for managing elevated intracranial pressure (ICP) due to malignant middle cerebral artery (MCA) infarction and intracranial hemorrhage (ICH). However, outcomes vary based on patient and procedural factors. Objective: This study aimed to evaluate the clinical outcomes, prognostic factors, and mortality associated with DC performed at King Khalid Hospital, Hail, Saudi Arabia. Patients and Methods: A retrospective analysis was conducted on 20 patients (16 males, 4 females; mean age 49 ± 10.5 years) who underwent DC between January 2022 and December 2024. Data included demographics, clinical presentation, radiological findings, surgical details, and outcomes. Preoperative Glasgow Coma Scale (GCS) scores, pathology type, and onset characteristics were analyzed. Mortality rates and functional outcomes were compared between MCA infarction and ICH cases using descriptive and inferential statistics. Results: The cohort included 10 patients with MCA infarction and 10 with ICH. The mean preoperative GCS was 8.0 ± 2.3. Mortality was 50% (10/20), with higher rates in MCA infarction (60%) compared to ICH (40%). Patients with left-sided pathologies exhibited better functional recovery (p < 0.05). Survivors demonstrated significant variability in outcomes, with higher preoperative GCS scores associated with improved recovery. Conclusion: DC remains an effective intervention for refractory ICP, with survival influenced by preoperative GCS, pathology type, and hemispheric involvement. Early intervention may improve outcomes, underscoring the need for timely surgical decision-making and comprehensive postoperative care.