Decompressive craniectomy (DC) is a recognized surgical strategy for patients experiencing critically elevated intracranial pressure (ICP) that does not respond to conservative medical therapy. Evidence regarding factors predicting functional outcomes in patients undergoing DC for malignant middle cerebral artery (MCA) infarction versus intracranial hemorrhage (ICH) remains limited. In this study, we retrospectively examined 84 patients who received DC for either ICH or malignant MCA infarction at the Salmaniya Medical Complex Neurosurgery Unit in Bahrain between January 2017 and June 2021. To explore associations with functional recovery, clinical characteristics were analyzed alongside radiographic parameters. Postsurgical midline shift (MLS) demonstrated the strongest correlation with outcomes in both ICH (ρ = 0.434, P = 0.006) and MCA infarction (ρ = 0.46, P = 0.005) cohorts. Binary logistic regression including postsurgical basal cistern status and ∆MLS revealed statistically significant predictive value (odds ratio: 0.067, 95% CI: 0.007–0.67, P = 0.021). Overall, initial Glasgow Coma Scale, postsurgical MLS, basal cistern patency, and ∆MLS were identified as reliable indicators of functional prognosis in both patient groups.
