Background: Our aim in the present study was to assess the value of Decompressive Craniectonyin acute SDH. We sought to assess whether the surgical procedure conferred any increase in short-term survival rates. We included all patients who underwent an operation in our unit for evacuation of an AcSDH sustained as a result of trauma, It is still not clear whether early decompression can improve the outcome in severe head injury (GCS 8 or <8) Aim & Objectives: - The study was conducted to assess the value of decompressive craniectomy in acute SDH and to evaluate the outcome / prognostic factors and complications of decompressivecraniectomy. Methods: - From Jan 2020 toDec 2022, 276 patients with Acute SDH due to trauma under went for Decompressive Craniectomy. The clinical status (GCS), imaging C.T. Scan/ MRI and outcome were analyzed at Neurosurgery unit of Surgery Dept. of Hamidia Hospital which is affiliated with Gandhi Medical College, Bhopal (India).Qi square independent test and Fishers test were used to evaluate the prognostic factor. Result: - Total numbers of 276 patients were treated surgically. The study group consisted of 276 male & female, with the mean age being 48.9±29.4 years, ranging between 2 and 75 years. The mechanisms of injury were traffic accidents in 76 (27%); fall in 24 (26%) and blunt injury due to occupational accidents in 6 (7%) patients. Left hemispheric injury was found in 38 (41%); right hemispheric injury in 16 (17%); and bilateral hemispheric injury in 16 (17%) patients. Acute SDH was the only injury in 28 (31%) patients, while the remaining 64 (69%) had accompanying extracranial injuries. Conclusion: Craniotomy can have favorable outcome in few cases of Acute SDH with unfavorable pre operative status, although craniectomy remain the standard surgical modality with pre operative poor clinical status. Early decompression in Acute SDH may be of particular benefit. The age of the patients, pupillary size and reaction at the time of admission was statistically significant predictor of outcome.Though, the indications of Decompressive Craniectony versus Craniotomyremain a matter of debate; the Brain Trauma Foundation has identified the question of craniotomy versus decompressivecraniectomy for primary evacuation of AcSDH as an vital area for further research.

Traumatic Brain Injury, DecompressiveCraniectomy, Acute subdural heamatoma, Outcome, Glasgow coma scale.