Efficacy of Decompressive Craniectomy on Long-term Functional Outcomes in Patients with Severe Acquired Brain Injury: A Systematic Review and Meta-analysis

AIM: To evaluate the efficacy of decompressive craniectomy (DC) on long-term functional outcomes in patients with severe acquired brain injury (ABI) through systematic review and meta-analysis. METHODS: We conducted a systematic review and meta-analysis of studies from 2010-2025. Nine studies (5 RCTs, 4 cohorts) with 3866 patients were included after quality assessment. Analysis was performed using RevMan 5.4. RESULTS: DC significantly improved functional outcomes at 12 months (OR = 3.63, 95% CI: 1.45-9.10) and reduced 12-month mortality (OR = 0.44, 95% CI: 0.21-0.90), despite high heterogeneity for mortality. No significant benefit was found for 6-month functional outcomes or complication rates. Subgroup analyses indicated that the survival benefit was more pronounced in Asian populations, and functional improvement was significant for both traumatic and non-TBI patients. CONCLUSIONS: DC provides significant long-term benefits for functional outcomes and survival in severe ABI patients, without increasing short-term complications. Its efficacy varies by ethnicity and etiology, suggesting a need for personalized treatment decisions.