Introduction Traumatic acute subdural haematoma (SDH) continues to have high morbidity and mortality rates despite the advent of rapid transportation, computed tomography (CT) scanning, intracranial pressure monitoring and intensive care management. 1,2 Outcome for these patients may be influenced mainly by the underlying brain injury than the SDH itself. 3 Despite studies on the impact of early craniectomy (EC) in traumatic acute SDH, 4,5 the value of primary decompressive craniectomy (DC) remains uncertain. To our knowledge, there are only two studies comparing mortality rates between normal craniotomy and DC. 3,6 In a group of 180 patients, one study reported a higher mortality rate in DC than EC. 3 However, the study had some pitfalls, as the two groups were not adjusted for age and Glasgow coma scale (GCS), or the presence of the signs of herniation. Consequently, subjects undergoing DC have had a higher rate of herniation and mortality than the subjects in the other group. 3 The other study reviewed a group of 34 patients having acute SDH. 6 The study performed DC in severe patients having significant brain oedema, while craniotomy was performed in less severe patients without any cliniclally devastating brain oedema. 6 The study failed to find any favourable neurological outcome in patients undergoing DC seemingly due to a randomisation pitfall. 6 Our aim in the present study was to assess the value of DC in acute SDH. We sought to assess whether the surgical procedure conferred any increase in short-term survival rates and long-term favourable outcomes defined by the Glasgow outcome scale (GOS) score in the study population. Special emphasis was placed on the relationship between patient characteristics and functional outcome to ascertain patient selection criteria that may ensure better surgical results in the future. Patients and Methods In this retrospective cross-sectional study, records of 34 J Pak Med Assoc 38 ORIGINAL ARTICLE Decompressive craniectomy for acute subdural haematoma: An overview of current prognostic factors and a discussion about some novel prognostic parametres Murat Kalayci, 1 Erol Aktunç, 2 Sanser Gül, 3 Volkan Hanci, 4 Nurullah Edebali, 5 Ferda Çagavi, 6 Bektas Açikgöz 7 Abstract Objective: To identify specific factors that can be used to predict functional outcome and to assess the value of decompressive craniectomy in patients with acute subdural haematoma. Methods: The retrospective study was done at the Zonguldak Karaelwas University Practice and Research Hospital, Turkey, and included 34 trauma patients who had undergone decompressive craniectomy for acute subdural haematoma from 2001 to 2009. At the 30th day of the operation, the patients were grouped as survivors and non-survivors. Besides, based on their Glasgow Outcome Scale, which was calculated 6 months post- operatively, the patients were divided into two functional groups: favourable outcomes (4-5 on the scale), and unfavourable outcomes (1-3 on the scale). The characteristics of the groups were compared using SPSS 15 for statistical analysis. Results: One-month mortality was 38.2% (n=13) and 6-month total mortality reached 47% (n=16). Patients with higher pre-operative revised trauma score, Glasgow coma scale, partial anterial pressure of carbon dioxide, arterial oxygen pressure, Charlson co-morbidity index score, blood glucose level, blood urea nitrogen, and lower age had a higher rate of survival and consequently a favourable outcome. Higher platelet values were only found to be a determinant of higher survival at the end of the first month without having any significant effect on the favourable outcome. Conclusion: In patients of traumatic acute subdural haematoma whose Glasgow coma scale on arrival was < 8, a massive craniectomy along with the evacuation of the haematoma, may be considered as a treatment option for intra-operative and post-operative brain swelling. But in patients with a score of 3 on arrival and bilaterally fixed and dilated pupils, decompressive craniectomy is unnecessary. Keywords: Acute subdural haematoma, Trauma, Decompressive craniectomy, Outcome. (JPMA 63: 38; 2013) 1,3,5,7 Departments of Neurosurgery, 2 Department of Family Medicine, 4 Department of Anesthesiology, Zonguldak Karaelmas University Medical School, 6 Department of Neurosurgery Kocaeli Acibadem Hospital, Turkey. Correspondence: Murat Kalayci. Email: drkalayci@yahoo.com