The management of massive brain swelling remains an unsolved problem in neurosurgical field. According to many recent reports, surgical decompression with dura expansion is effective in major cerebral infarction. To evaluate the decompressive surgical effect on the different diseases, we analyzed the clinical outcome whom were underwent decompressive surgery.

Eighty patients with massive brain swelling, with Glasgow Coma Scale (GCS) less than 8 scores and midline shift more than 10 mm on CT were included in this study. 38 cases of traumatic brain injury (TBI), 24 cases of hypertensive intracerebral hematoma (H-ICH), 12 cases of major infarction and 6 cases of vasospasm after subarachnoid hemorrhage (SAH) were analyzed. In all patients, bilateral or unilateral craniectomy with dura expansion were performed, and the ventricular pressure was monitored through the operation.

The mean GCS scores that evaluated 3 months after the decompressive surgery were 9.4 in TBI, 9.5 in H-ICH, 3.1 in major infarction and 4.3 in vasospasm patients group. The mortality was 24% in TBI, 21% in H-ICH, 75% in major infarction and 66% in vasospasm patients group.

Bilateral decompression with dura expansion is a effective therapeutic modality in intracranial pressure (ICP) control. To obtain favorable clinical outcome in patients with major stroke and vasospasm, early decision making should be done compare with the TBI and H-ICH patients.