Decompressive craniectomy for intracerebral haemorrhage in contemporary practice: a Swedish, multi-centre study of utilization, indications, and outcomes

BACKGROUND: This multi-centre study aimed to describe indications and outcomes in spontaneous supratentorial intracerebral haemorrhage (ICH) patients treated with decompressive craniectomy (DC). METHODS: All patients undergoing DC for spontaneous ICH at five Swedish neurosurgical centres between 2008 and 2022 were included (n = 45). Clinical, radiological, and outcome data were extracted. Outcome at six months was assessed using the modified Rankin Scale (mRS), dichotomized as favourable vs. unfavourable (mRS 0-3 vs. 4-6), and survival vs. mortality (mRS 0-5 vs. 6). RESULTS: Based on estimated ICH incidence, DC was performed in approximately 1.5 per 1000 cases. Median age was 47 years and the median ICH volume was 51 mL. Eighty-nine percent underwent ICH evacuation. DC performed as a primary procedure without ICP monitoring in 33%, whereas 67% underwent secondary DC due to refractory ICP elevation. Preoperative midline shift (median 11 mm) and basal cistern compression (present in 96%) significantly improved postoperatively (p < 0.001). Reoperation occurred in