Outcome Following Decompressive Craniectomy in a Tertiary Care Center in Nepal

  • Ashim Gurung TUTH
  • Anjan Singh Karki
  • Dipendra Kumar Shrestha
  • Binod Rajbhandari
  • Amit B Pradhanang
  • Gopal Sedain
  • Sushil Krishna Shilpakar
  • Mohan Raj Sharma


Outcome Following Decompressive Craniectomy in a Tertiary Care Center in Nepal
Ashim Gurung, Anjan Singh Karki, Dipendra Kumar Shrestha, Binod Rajbhandari, Amit B Pradhanang, Gopal Sedain, Sushil Krishna Shilpakar, Mohan Raj Sharma
Decompressive Craniectomy (DC) is a common neurosurgical procedure performed to reduce the intractable intracranial pressure in various neurosurgical diseases (infarction, hemorrhage, traumatic brain injury). The main aim of the study was to describe the demographic, clinical and operative characteristics of patients who underwent DC for different conditions and to correlate the outcome with various preoperative and intraoperative factors in our center.
This was a retrospective study of patients who underwent DC for various neurosurgical diseases from January 2019 to January 2021 in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The chart of the patients were retrieved from the medical records and additional information obtained via telephone.
A total of 55 patients were enrolled in the study with a mean age of 43.0 + 17.3 years and male:female ratio of 1.5:1. There were 20 (36.4%) patients who presented with trauma and 35 (63.6%) patients with non traumatic origin. Among them, 28 (51%) patients presented with GCS<8 and 27 (49%) patients with GCS>8 and 37 (67.3%) patients with unequal pupil. At the end of six months follow up, the favorable outcome was seen in 23 (41.8%) patients. The only factor significantly associated with favorable outcome was the preoperative pupillary status.
In our cohort the preoperative pupillary status (bilateral equal and reactive pupil) was the variable significant for favourable outcome in patients undergoing DC.

Author Biographies

Anjan Singh Karki
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Dipendra Kumar Shrestha
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Binod Rajbhandari
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Amit B Pradhanang
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Gopal Sedain
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Sushil Krishna Shilpakar
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.
Mohan Raj Sharma
Department of Neurosurgery, Institute ofMedicine, Kathmandu, Nepal.


1. 1. Kim KT, Park JK, Kang SG, Cho KS, Yoo DS, Jang DK, Huh PW, Kim DS. Comparison of the effect of decompressive craniectomy on different neurosurgical diseases. Acta Neurochir (Wien). 2009 Jan;151(1):21-30.
2. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017 Jan 1;80(1):6-15.
3. Stocchetti N, Picetti E, Berardino M, Buki A, Chesnut RM, Fountas KN, Horn P, Hutchinson PJ, Iaccarino C, Kolias AG, Koskinen LO, Latronico N, Maas AI, Payen JF, Rosenthal G, Sahuquillo J, Signoretti S, Soustiel JF, Servadei F. Clinical applications of intracranial pressure monitoring in traumatic brain injury : report of the Milan consensus conference. Acta Neurochir (Wien). 2014 Aug;156(8):1615-22.
4. Grindlinger GA, Skavdahl DH, Ecker RD, Sanborn MR. Decompressive craniectomy for severe traumatic brain injury: clinical study, literature review and meta-analysis. Springerplus. 2016 Sep 20;5(1):1605.
5. Kolias AG, Kirkpatrick PJ, Hutchinson PJ. Decompressive craniectomy: past, present and future. Nat Rev Neurol. 2013 Jul;9(7):405-15.
6. Hofmeijer J, Amelink GJ, Algra A, van Gijn J, Macleod MR, Kappelle LJ, van der Worp HB; HAMLET investigators. Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in space-occupying hemispheric infarction. Trials. 2006 Sep 11;7:29.
7. Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, Witte S, Jenetzky E, Hacke W; DESTINY Study Group. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke. 2007 Sep;38(9):2518-25.
8. Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, Boutron C, Couvreur G, Rouanet F, Touzé E, Guillon B, Carpentier A, Yelnik A, George B, Payen D, Bousser MG; DECIMAL Investigators. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007 Sep;38(9):2506-17.
9. Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D'Urso P, Kossmann T, Ponsford J, Seppelt I, Reilly P, Wolfe R; DECRA Trial Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011 Apr 21;364(16):1493-502.
10. Hutchinson PJ, Kolias AG, Timofeev IS, Corteen EA, Czosnyka M, Timothy J, Anderson I, Bulters DO, Belli A, Eynon CA, Wadley J, Mendelow AD, Mitchell PM, Wilson MH, Critchley G, Sahuquillo J, Unterberg A, Servadei F, Teasdale GM, Pickard JD, Menon DK, Murray GD, Kirkpatrick PJ; RESCUEicp Trial Collaborators. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med. 2016 Sep 22;375(12):1119-30.
11. Shah DB, Paudel P, Joshi S, Karki P, Sharma GR. Outcome of Decompressive Craniectomy for Traumatic Brain Injury: An Institutional-Based Analysis from Nepal. Asian J Neurosurg. 2021 May 28;16(2):288-293.
12. Nepal PR, Rijal S. Outcome Following Decompressive Surgery for Malignant Middle Cerebral Artery Infarction. East Green Neurosurg. 2020 Jan 29;2(1):23–6
13. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480-4.
14. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418.
15. Lin J, Frontera JA. Decompressive Hemicraniectomy for Large Hemispheric Strokes. Stroke. 2021 Apr;52(4):1500-1510.
16. Kunze E, Meixensberger J, Janka M, Sörensen N, Roosen K. Decompressive craniectomy in patients with uncontrollable intracranial hypertension. Acta Neurochir Suppl. 1998;71:16-8.
17. Fung C, Murek M, Z'Graggen WJ, Krähenbühl AK, Gautschi OP, Schucht P, Gralla J, Schaller K, Arnold M, Fischer U, Mattle HP, Raabe A, Beck J. Decompressive hemicraniectomy in patients with supratentorial intracerebral hemorrhage. Stroke. 2012 Dec;43(12):3207-11.
18. Dastur CK, Yu W. Current management of spontaneous intracerebral haemorrhage. Stroke Vasc Neurol. 2017 Feb 24;2(1):21-29.
19. Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus. 2013 May;34(5):E5.
20. Morgenstern LB, Frankowski RF, Shedden P, Pasteur W, Grotta JC. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology. 1998 Nov;51(5):1359-63. doi: 10.1212/wnl.51.5.1359. PMID: 9818860.
21. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM; STICH II Investigators. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013 Aug 3;382(9890):397-408.
22. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60.
23. Molina CA, Selim MH. Decompressive hemicraniectomy in elderly patients with malignant hemispheric infarction: open questions remain beyond DESTINY. Stroke. 2011 Mar;42(3):847-8.
24. Kapoor A, Lanctôt KL, Bayley M, Kiss A, Herrmann N, Murray BJ, Swartz RH. "Good Outcome" Isn't Good Enough: Cognitive Impairment, Depressive Symptoms, and Social Restrictions in Physically Recovered Stroke Patients. Stroke. 2017 Jun;48(6):1688-1690.
How to Cite
GURUNG, Ashim et al. Outcome Following Decompressive Craniectomy in a Tertiary Care Center in Nepal. J Soc Surg Nep, [S.l.], v. 24, n. 2, p. 36-41, feb. 2022. ISSN 2392-4772. Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=458>. Date accessed: 01 dec. 2023.