Emergency Decompressive Craniectomy Research Articles

Simultaneous Emergency Cesarean Delivery and Decompressive Craniectomy for Meningioma in a Parturient with Systemic Lupus Erythematosus – A Case Report and Literature Review

A strong association is reported between the level of sex hormones and an accelerated growth of meningioma in a parturient. Consequently, a rapidly enlarging, symptomatic intracranial meningioma poses grave risk to the mother and fetus, warranting emergency craniectomy as a life-saving measure regardless of the status of pregnancy. Comorbidities such as systemic lupus erythematosus (SLE) may complicate the perinatal management. Raised intracranial pressure (ICP), hemodynamic Instability, maintaining cerebral and utero-placental perfusion coupled with administering general anesthesia (GA) in a parturient with inherent difficult airway are some of the anesthetic challenges. SLE, an autoimmune, multisystem inflammatory disorder presents unique anesthetic implications in obstetrics due to its variable manifestation depending upon the extent of systemic involvement, acute exacerbations and therapeutic interventions. We present a case of emergency lower segment cesarean section (LSCS) with simultaneous decompressive craniectomy for meningioma in a 41-year-old, 32-week-parturient comorbid with SLE. She presented to the emergency room with headache, confusion, right-sided hemiparesis, ptosis of the left eye and bradycardia. Magnetic resonance imaging revealed left frontal–parietal meningioma causing mass effect along with uncal and subfalcine herniation. An urgent multidisciplinary conference decided to perform emergency cesarean delivery followed by decompressive hemicraniectomy in the same sitting under GA. This is a first such case report that discusses the anesthetic management of a parturient comorbid with SLE and intracranial meningioma undergoing emergency decompressive hemicraniectomy and LSCS under GA simultaneously. We aim to highlight the multidisciplinary approach, expert anesthetic management and tertiary care hospital resources which helped to optimize the management of such a complex case.

Abstract 408: Spontaneous intracerebral hemorrhage in a patient with multiple sclerosis : A case of vascular complication of a demyelinating disorder

Introduction Intracerebral hemorrhage [ICH] accounts for only 6.5% to 19.6% of strokes, yet with a 40% to 50% 30‐day mortality rate [twice that of ischemic strokes]. It presents as acute onset focal neurological deficits that localize to the area of hemorrhage. Most common causes of spontaneous ICH include hypertension [HTN] and cerebral amyloid angiopathy [CAA]. Multiple sclerosis [MS] is the most prevalent non‐traumatic disabling demyelinating disease that affects young adults. Most commonly, MS presents with optic neuritis or syndromes involving the brainstem or spinal cord. This case aims to bolster the assertion that demyelinating lesions “set the stage” for ICH through a variety of pathophysiologic mechanisms. Methods [Case Presentation] A 40 year old woman with a history of chronic well controlled HTN without medications, hypothyroidism, active tobacco use, not on anticoagulation or antiplatelet agents was hospitalized for progressively worsening blurry vision of her left eye. She underwent MRI brain/orbits +/‐ contrast and lumbar puncture and was diagnosed with MS per McDonald's criteria. She completed a five day course of intravenous methylprednisolone. Six days into her hospital stay, just after completing the steroid course, she developed sudden onset of altered mental status and left sided hemiparesis. Imaging revealed a right frontal intraparenchymal hematoma measuring 3.7 times 5.4 times 4.1 cm with surrounding edema causing effacement of the right lateral ventricle and a 5 mm leftward midline shift. Patient required emergent intubation and decompressive craniectomy. She showed no evidence of elevated blood pressures prior to ICH [systolic blood pressure range 95‐146], hypercoagulability or other autoimmune/rheumatological disorders. Digital subtraction angiography did not reveal any vascular malformations. No clear etiology of ICH could be determined and she was discharged to inpatient rehabilitation unit. Conclusion This case represents a rare instance of spontaneous ICH in MS patients, in which the pathophysiologic processes are not yet known. One potential hypothesis is the rupture of ‘cryptic’ AVMs that remain undetected on angiography. These aneurysms are prone to rupture in the setting of active ongoing inflammation from demyelination during MS exacerbations. Another possibility is localized vascular inflammation rendering damage to vessel wall structures. A large retrospective cohort study has also shown that age, smoking and anticoagulant use increase the risk of ICH in MS patients. One paper posits that demyelinating lesions set the stage for focal hemorrhage through various mechanisms, including blood brain barrier breakdown at the location of the demyelinating plaques, as well as increased endothelial fragility, transient thrombocytopenia, close proximity of the lesion to blood vessels, and increased fibrinolytic activity. Though theoretical, this may explain the rare hemorrhagic complications in MS patients. While there have been reports of hemorrhagic lesions in tumefactive MS, our case did not reveal any lesions suggestive of the same. The association between ICH and MS remains unclear, and larger studies are needed to investigate such hemorrhagic complications of MS.

Unforeseen outcomes: Unveiling cyst formation post stereotactic radiosurgery in brain arteriovenous malformations cases

IntroductionCyst formation after stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs) is a rare, delayed but important complication. Prompt recognition and appropriate treatment is essential for good outcome. MethodsWe analysed our institute’s Gamma knife treatment records from 2008 to 2023 and analysed AVM treated patients by gamma knife radiosurgery (GKRS). Patients with cyst formation and with adequate follow up were identified. Clinical details, management and prognosis of these patients was studied in detail along with prior literature review. ResultsA total of 921 AVM patients were treated in the above period and 7 patients were identified with cyst formation. The mean nidus volume was 12.98 ml, the mean radio surgical marginal dose was 23.57 Gy and maximal dose 47.21 Gy. The mean interval gap between SRS and cyst detection was 6.45 years. The mean volume of cyst cavity formed was 47.85 ml. Patients presented either with features of raised intracranial pressure (3) or focal neurological deficits (3) or seizures (1). 3 patients had achieved angiographic nidus obliteration at the time of cyst detection. Treatment was mostly on surgical lines with cyst fenestration(2 patients), excision (3 patients) and emergency decompressive craniectomy (1 patient). 1 patient required additional Ommaya insertion. Conservative management was followed for 1 patient. Residual nidus was treated either by concomitant excision or embolization or redo GKRS.Favourable outcome was seen in 6 out of 7 patients (85.71%) post cyst management with symptomatic and radiological improvement whereas 1 patient (14.28%) died due to refractory status epilepticus secondary to malignant cerebral edema. ConclusionCyst formation after GKRS for AVM treatment is an often-neglected complication due to its low incidence and often long latency period. Long term follow up of patients is hence necessary for prompt recognition. Diagnostic DSA should be done in all patients with cysts to look for residual nidus. Asymptomatic ones can be followed up conservatively while surgical treatment is required for symptomatic cases. Ventricular diversion like Ommaya or cystoperitoneal shunt may be necessary in some cases. Treatment outcome is usually favourable provided timely detection is done.

Analysis of Factors Related to the Efficacy of Consciousness-Regaining Therapy for Prolonged Disorder of Consciousness: A Retrospective Cohort Study

To analyse the factors related to the efficacy of consciousness-regaining therapy for prolonged disorder of consciousness. A retrospective analysis was conducted on the case data of 114 patients with pDOC admitted to the Department of Functional Neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2022 to explore the relevant factors that affect the efficacy of consciousness-regaining therapy (CRT) for prolonged disorder of consciousness (pDOC). Next, basic information on the cases, data on pDOC disease assessment, CRT methods, and efficacy evaluation were collected. These 114 patients were grouped, and a comparative analysis was done based on the efficacy at the end of treatment. Of these, 61 cases were allotted to the ineffective group and 53 cases to the effective group. There was a lack of statistical difference (P > 0.05) between the two groups based on gender, age, etiology, acute cerebral herniation, emergency craniotomy surgery, emergency decompressive craniectomy, time from onset to start of CRT, and CRT duration (P > 0.05). However, secondary hydrocephalus, CRT methods, CRS-R grading before treatment, and GOSE score at six months after treatment were found to be statistically different. The results of binary logistic regression analysis showed that the type of therapy (OR = 0.169, 95% CI: 0.057-0.508) affected the efficacy of CRT (P < 0.05). Personalized awakening therapy using various invasive CRT methods could improve the efficacy of therapy for pDOC compared with non-invasive therapy.

Craniotomy versus craniectomy for traumatic acute subdural hematoma—coarsened exact matched analysis of outcomes

Background and objectivesAcute subdural hematoma (aSDH) after traumatic brain injury frequently requires emergent craniotomy (CO) or decompressive craniectomy (DC). We sought to determine the variables associated with either surgical approach and to compare outcomes between matched patients. MethodsA multi-center retrospective review was used to identify traumatic aSDH patients who underwent CO or DC. Patient variables independently associated with surgical approach were used for coarsened exact matching.Multivariate logistic regression and multivariate Cox proportional-hazards regression wereconducted on matched patients to determine independent predictors of mortality. ResultsSeventy-six patients underwent CO and sixty-two underwent DC for aSDH evacuation. DC patients were21.4 years younger (P < 0.001), more likely to be male (80.6 % vs 60.5 %,P = 0.011), and present with GCS ≤ 8 (64.5 % vs 36.8 %,P = 0.001). Age (P < 0.001), epidural hematoma (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and intraventricular hemorrhage (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003). ConclusionaSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is independently associated with mortality.

Potentially fatal cerebral venous sinus thrombosis followed by a hemorrhagic stroke in a vaccinated patient: Do not rule out COVID-19 as a reason

Stroke is amongst the leading causes of morbidity and mortality globally. Majority of strokes are ischemic and up to 1/3rd ischemic strokes have infective etiology. In this post-pandemic era, SARS-CoV-2 is an established infectious agent which can precipitate it by various mechanisms. Though post-vaccination incidence of COVID-19 has dropped drastically, still new cases get reported with typical or atypical presentations. Irrespective of causation, malignant cerebral edema in stroke necessitates salvage neurosurgery. Hereby authors present an interesting diagnostic chase in a young female who presented in altered sensorium, underwent emergency decompressive craniectomy and neurologically recovered over subsequent days. Despite being double vaccinated, she developed potentially fatal COVID-encephalitis, cerebral venous sinus thrombosis (CVST), ischemic infarcts and hemorrhagic transformation. Suprisingly, there were cross reacting antibodies against antigens of herpes simplex virus (HSV), leptospira and cytomegalovirus (CMV) yielding false positivity on serology screening test, which spoofed us while carrying out infectious disease work up of stroke.

Neuromelioidosis Presenting as Cerebral Venous Thrombosis Requiring Emergency Decompressive Craniectomy and Prolonged Neurointensive Care

Neuromelioidosis Presenting as Cerebral Venous Thrombosis Requiring Emergency Decompressive Craniectomy and Prolonged Neurointensive Care

P98 Management of emergency caesarean delivery and decompressive craniectomy for parturient with an acutely decompensated glioblastoma

P98 Management of emergency caesarean delivery and decompressive craniectomy for parturient with an acutely decompensated glioblastoma

Intracranial peak pressure as a predictor for perioperative mortality after spontaneous intracerebral hemorrhage evacuation and decompressive craniectomy

BackgroundAn optimal intracranial pressure (ICP) management target is not well defined in patients with spontaneous intracerebral hemorrhage. The aim of this study was to explore the association between perioperative ICP monitoring parameters and mortality of patients with spontaneous intracerebral hematoma undergoing emergency hematoma removal and decompressive craniectomy (DC), to provide evidence for a target-oriented ICP management.MethodsThe clinical and radiological features of 176 consecutive patients with spontaneous intracerebral hemorrhage that underwent emergent hematoma evacuation and DC were reviewed. The Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores were assessed 2 weeks after surgery. Multivariate logistic regression analysis was performed to identify predictors for perioperative death.ResultsForty-four cases (25.0%) were assigned to the ICP group. In patients with an ICP monitor, the median peak ICP value was 25.5 mmHg; 50% of them had a peak ICP value of more than 25 mmHg. The median duration of ICP > 25 mmHg was 2 days. Without a target-specific ICP management, the mortality at 2 weeks after surgery was similar between patients with or without an ICP monitor (27.3% versus 18.2%, p = 0.20). In multivariable analysis, the peak ICP value (OR 1.11, 95% CI 1.004–1.234, p = 0.04) was significantly associated with perioperative death in the ICP group. The area under ROC curve of peak ICP value was 0.78 (95%CI 0.62–0.94) for predicting mortality, with a cut-off value of 31 mmHg.ConclusionCompared with a persistent hyperintracranial pressure, a high ICP peak value might provide a better prediction for the mortality of patients with spontaneous intracerebral hemorrhage evacuation and DC, suggesting a tailored ICP management protocol to decrease ICP peak value.

Patient Outcomes following Immediate Tracheostomy and Emergency Decompressive Craniectomy in the Same Setting

Early tracheostomy is recommended for patients with severe traumatic brain injury or stroke. Tracheostomy in the same setting as emergency decompressive craniectomy, on the other hand, has never been investigated. Our goal was to compare the outcomes related to the duration of mechanical ventilation in patients who had immediate (IT) vs. early (ET) tracheostomy following an emergency decompressive craniectomy in a Neurosurgical centre in Sabah, Malaysia. We reviewed 135 patients who underwent emergency decompressive craniectomy for traumatic brain injury (TBI) and stroke patients between January 2013 and January 2018 in this retrospective cohort study. The cohort included 49 patients who received immediate tracheostomy (IT), while the control group included 86 patients who received a tracheostomy within 7 days of decompressive surgery (ET). The duration of mechanical ventilation, length of stay (LOS) in the critical-care unit, and intravenous sedation were significantly shorter in the IT group compared to the ET group, according to the study. There was no significant difference between the two groups in the incidence of ventilator-associated pneumonia (VAP), tracheostomy-related complications, or 30-day mortality rate. In conclusion, compared to early tracheostomy, immediate tracheostomy in the same setting as emergency decompressive craniectomy is associated with a shorter duration of mechanical ventilation and LOS in critical-care units with acceptable morbidity and mortality rates. This practise could be used in busy centres with limited resources, such as those where mechanical ventilators, critical-care unit beds, or OT wait times are an issue.

Aortic repair following initial decompressive craniectomy for acute type A aortic dissection complicated with extensive hemorrhagic cerebral infarction: a case report

A 69-year-old woman presented with acute type A aortic dissection complicated by extensive hemorrhagic cerebral infarction due to brain malperfusion. Emergency decompressive craniectomy was initially performed, with an initial diagnosis of hemorrhagic cerebral infarction. The patient was referred for surgical management following a diagnosis of acute type A aortic dissection. After stabilizing the neurological condition with medical treatment for nine weeks, hemiarch replacement was performed electively. The postoperative course was uneventful, with no new neurological disorders. Subsequently, she recovered sufficiently to have daily conversations and attend hospital appointments using a wheelchair.

Predictive Mortality Factors after Decompressive Craniectomy in Ischemic Stroke

Abstract Background Decompressive craniectomy is a consolidated method for the treatment of malignant ischemic stroke (iS) in the territory of the middle cerebral artery. Thus, factors contributing to mortality constitute an important area of investigation. Objective To evaluate the epidemiological clinical profile and predictors of mortality in a single-center population of patients undergoing decompressive craniectomy for the treatment of malignant iS. Methods A single-center retrospective study was performed in 87 patients with malignant iS subjected to emergency decompressive craniectomy from January 2014 to December 2017. Age, gender, laterality, aphasia, time interval between disease onset and treatment, and clinical and neurological outcomes using the Glasgow coma scale were assessed. The patients were stratified by age: a group of participants 60 years old or younger, and a group of participants older than 60 years old for assessment of survival and mortality by the Kaplan-Meier test and log-rank comparison. The intensity of the association between demographic and clinical variables was evaluated by multivariate Cox regression. Results Ischemic stroke was prevalent in patients with hypertension (63.29%). Seventy-seven (84%) patients had some type of postoperative complication, mostly pneumonia (42.8%). The risk of death was 2.71 (p = 0.0041) and 1.93 (p = 0.0411) times higher in patients older than 60 and with less than 8 points on the Glasgow coma scale, respectively. Conclusion Malignant iS has a significant mortality rate. Age above 60 years and Glasgow coma scale values below 8 were statistically correlated with unfavorable prognosis.

Cerebral venous sinus thrombosis-associated hemorrhage in vaccine-induced immune thrombotic thrombocytopenia: Catastrophic outcome if delayed diagnosis and treatment

The authors reported the clinical course of a 58-year-old female suffering from cerebral venous sinus thrombosis associated with hemorrhage after the ChAdOx1 nCov-19 vaccination. Emergent decompressive craniectomy was performed, and aggressive blood transfusion was given. Nevertheless, progressive intracerebral hemorrhage and thrombocytopenia developed. A delayed diagnosis was made on a rare complication of vaccine-induced immune thrombotic thrombocytopenia (VITT) with a positive result of anti-platelet factor 4 antibodies (PF4 Ab). The patient died 4 days postoperative due to brainstem failure.

Real-Time Imaging of Aneurysmal Rupture Causing an Isolated Acute Subdural Hematoma.

A 51-year-old woman with hypertension presented with a 3-week history of progressive right cranial nerve III palsy and headache. During emergency department evaluation, while in the MRI scanner, she became acutely unresponsive. MRI captured a rapidly expanding acute subdural hematoma (aSDH) (Figure). She was taken for emergent decompressive craniectomy. Postoperative imaging demonstrated a ruptured right-sided posterior communicating artery aneurysm.

Rare Case of Left Ventricular Thrombus Postmyocardial Infarction for Emergency Decompressive Craniectomy

AbstractLeft ventricular (LV) thrombus formation is a notorious complication encountered in postmyocardial infarction patients. Such cases, when coming for noncardiac surgery, put the patient at greater risk of embolic events. Anesthesiologists play a pivotal role in the management of such rare and difficult cases. There is sparse evidence on management of such cases for noncardiac surgery. Hence, we would like to share our experience of a young patient with LV thrombus posted for left decompressive craniectomy.

675 ICA Ligation and Malignant MCA Syndrome Secondary to A Gunshot Wound: A Case Presentation

Abstract Penetrating carotid injuries occur infrequently in the UK. Without surgical intervention, mortality rates are close to 100%. Whilst vessel repair is the optimal surgical choice, zone III neck injuries or haemodynamic instability in particular often require vessel ligation, which carries higher mortality rates, increased risk of stroke and poorer outcomes overall. We present a young patient who sustained a gunshot wound to the neck. Emergency exploration revealed a penetrating injury to zone III of the left side of the neck and a complete transection of the left internal carotid artery. Due to haemodynamic instability, damage control surgery was mandated, and the internal carotid artery was ligated. The patient was admitted to ITU but had a severe acute neurological deterioration post-operation. CT head imaging revealed a large left frontal-parietal infarct with rightward midline shift, in keeping with malignant MCA syndrome. He underwent an emergency decompressive craniectomy, with resolution of the midline shift seen on subsequent imaging. At 3 months, the patient walked independently out of hospital, with a reduction in his modified Rankin Scale score from 5 to 2 following intensive therapies input. Whilst rare, the importance of timely recognition and intervention of an infrequent complication of carotid ligation is paramount. Decompressive craniectomy is the mainstay of treatment for malignant MCA syndrome, yet outcomes remain poor in all ages, highlighting the patient’s noteworthy recovery. Though emerging evidence suggests novel endovascular repair techniques may provide favourable outcomes and reduced complications in carotid injuries, open surgery remains the treatment of choice.

Sphenoparietal sinus and superficial middle cerebral vein thrombosis: A case report and review of literature

BackgroundCerebral venous sinus thrombosis is rare and might be overlooked by healthcare providers. It often occurs in the transverse sinuses, superior sagittal sinus, and the vein of Trolard. Sphenoparietal sinus (SPS) and/or superficial middle cerebral vein (SMCV) thrombosis is rare and only 12 cases reported in the literature. Case descriptionWe report a 47-year-old woman with iron deficiency anemia associated with myoma uteri who developed left SPS and SMCV thrombosis. She presented with sudden unconsciousness, right hemiplegia, and aphasia. Brain computed tomography showed subcortical hemorrhages in the left frontal and temporal lobes. Magnetic resonance imaging did not reveal the cause of the bleeding. Although antihypertensive treatment with nicardipine was initiated, she deteriorated into coma the next day and underwent emergency decompressive craniectomy. Thrombosis of the SMCV was identified during surgery. Re-examination of preoperative T2 star-weighted imaging revealed thrombosis of the SPS and SMCV. ConclusionAll but one of the reviewed cases had the thrombosis develop on the left side, which may be attributed to anatomical and brain functional laterality. When an edematous change or cortical hemorrhage of unknown cause is encountered within the perisylvian region, especially on the left side, the possibility of SPS and SMCV thrombosis should be considered.

Large left ventricular thrombus with malignant left MCA infarct for emergency decompressive craniectomy.

Large left ventricular thrombus with malignant left MCA infarct for emergency decompressive craniectomy.

Outcomes of Traumatic Brain-Injured Patients With Glasgow Coma Scale < 5 and Bilateral Dilated Pupils Undergoing Decompressive Craniectomy.

Objective: Decompressive craniectomy (DC) plays an important role in the treatment of patients with severe traumatic brain injury (sTBI) with mass lesions and intractably elevated intracranial hypertension (ICP). However, whether DC should be performed in patients with bilateral dilated pupils and a low Glasgow Coma Scale (GCS) score is still controversial. This retrospective study explored the clinical outcomes and risk factors for an unfavorable prognosis in sTBI patients undergoing emergency DC with bilateral dilated pupils and a GCS score <5.Methods: The authors reviewed the data from patients who underwent emergency DC from January 2012 to March 2019 in a medical center in China. All data, such as patient demographics, radiological findings, clinical parameters, and preoperative laboratory variables, were extracted. Multivariate logistic regression analysis was performed to determine the factors associated with 30-day mortality and 6-month negative neurological outcome {defined as death or vegetative state [Glasgow Outcome Scale (GOS) score 1–2]}.Results: A total of 94 sTBI patients with bilateral dilated pupils and a GCS score lower than five who underwent emergency DC were enrolled. In total, 74 patients (78.7%) died within 30 days, and 84 (89.4%) had a poor 6-month outcome (GOS 1–2). In multivariate analysis, advanced age (OR: 7.741, CI: 2.288–26.189), prolonged preoperative activated partial thromboplastin time (aPTT) (OR: 7.263, CI: 1.323–39.890), and low GCS (OR: 6.162, CI: 1.478–25.684) were associated with a higher risk of 30-day mortality, while advanced age (OR: 8.812, CI: 1.817–42.729) was the only independent predictor of a poor 6-month prognosis in patients undergoing DC with preoperative bilateral dilated pupils and a GCS score <5.Conclusions: The mortality and disability rates are extremely high in severe TBI patients undergoing emergency DC with bilateral fixed pupils and a GCS score <5. DC is more valuable for younger patients.

Lifesaving Decompressive Craniectomy for High Intracranial Pressure Attributed to Deep-Seated Meningioma: Emergency Management.

Objects:As the most common intracranial extra-axial tumor among adults who tend to grow slowly with minimal clinical manifestation, the patients with meningioma could also fall in neurological emergency and even life-threatening status due to high intracranial pressure (ICP). In those circumstances, decompressive craniectomy (DC) without definitive tumor resection might offer an alternative treatment to alleviate acute increasing of ICP. The current report defines criteria for the indications of lifesaving DC for high ICP caused by deep-seated meningioma as an emergency management.Patients and Methods:This study collected the candidates from 2012 to 2018 at Dr. Soetomo General Hospital, Surabaya, Indonesia. The sample included all meningioma patients who came to our ER who fulfilled the clinical (life-threatening decrease in Glasgow Coma Scale [GCS]) and radiography (deep-seated meningioma, midline shift in brain computed tomography [CT] >0.5 cm, and diameter of tumor >4 cm or tumor that involves the temporal lobe) criteria for emergency DC as a lifesaving procedure. GCS, midline shift, tumor diameter, and volume based on CT were evaluated before DC. Immediate postoperative GCS, time to tumor resection, and Glasgow Outcome Scale (GOS) were also assessed postoperation.Results:The study enrolled 14 patients, with an average preoperative GCS being 9.29 ± 1.38, whereas the mean midline shift was 15.84 ± 7.02 mm. The average of number of tumor's diameter and volume was 5.59 ± 1.44 cm and 66.76 ± 49.44 cc, respectively. Postoperation, the average time interval between DC and definitive tumor resection surgery was 5.07 ± 3.12 days. The average immediate of GCS postoperation was 10.07 ± 2.97, and the average GOS was 3.93 ± 1.27.Conclusion:When emergency tumor resection could not be performed due to some limitation, as in developing countries, DC without tumor resection possibly offers lifesaving procedure in order to alleviate acute increasing ICP before the definitive surgical procedure is carried out. DC might also prevent a higher risk of morbidity and postoperative complications caused by peritumoral brain edema.