Publication:

Survival outcomes following decompressive craniectomy versus reconstructive cranioplasty: a comparative study

Background Decompressive craniectomy is lifesaving for malignant cerebral edema after trauma or stroke. Subsequent cranioplasty restores cranial integrity and may improve neurological recovery; however, comparative outcome data from Bangladesh remain limited.

Methods This comparative study was conducted at KPJ Specialized Hospital, Dhaka, Bangladesh, from September 2017 to December 2024. A purposive sample of 47 patients who underwent decompressive craniectomy was included and divided into two groups: the DC-only group (n=31) and the DC+CP group (n=16). Survival was the primary outcome measure. Data were analyzed using SPSS version 23.0.

Results Patients in the DC+CP group were significantly younger than those in the DC-only group (p =0.009). A marked difference in survival was observed between groups: 93.8% (15/16) of patients in the DC+CP group were alive at follow-up, compared to 25.8% (8/31) in the DC-only group (p<0.001). Syndrome of the trephined was identified in 25.0% (4/16) of patients before cranioplasty. Following CP, 87.5% (14/16) demonstrated neurological improvement, and 68.8% (11/16) achieved good functional recovery (Glasgow Outcome Scale score 4–5). The overall CP-related complication rate was 18.8%.

Conclusions Survival was substantially higher among patients who underwent cranioplasty following decompressive craniectomy. Despite inherent selection bias, cranioplasty was strongly associated with improved neurological and functional outcomes, underscoring its critical role in the continuum of care for severe neurotrauma and stroke.