Objective: To evaluate mortality, morbidity, and prognostic factors affecting survival in patients who underwent decompressive craniectomy (DC) for various etiologies in a tertiary neurosurgical center.

Materials and Methods: A retrospective review was conducted on 50 patients who underwent DC between January 2018 and December 2024. Demographic, clinical, radiological, and surgical variables were analyzed. The primary outcome was in-hospital mortality; secondary outcomes included length of clinical follow-up, hospitalization duration, and comorbidity-related effects. Statistical significance was set at p<0.05.

Results: The mean age was 55.9 ± 14.2 years, and 56% of the patients were male. The most common pathology was subarachnoid hemorrhage (44%). Mean clinical follow-up duration was 42.4 ± 57.0 days. Overall mortality rate was 40% (n=20). There were no significant differences in age or sex between survivors and non-survivors (p>0.05). Comorbidity was significantly associated with higher mortality (p=0.020). The most frequently performed surgical technique was frontotemporoparietal decompression (62%). Bilateral DC was performed in only one patient, preventing meaningful comparison.

Conclusion: DC remains a life-saving intervention in the management of refractory intracranial hypertension and malignant cerebral edema. Despite its benefits, mortality remains substantial, and comorbidities significantly worsen survival. Surgical decision-making should incorporate clinical status, radiological findings, patient age, and systemic disease burden. These findings are consistent with the existing literature, underscoring the need for larger prospective studies.

Keywords: intracranial hypertension, decompressive craniectomy, subarachnoid hemorrhage, survival, decompressive surgery