To present the impact of decompressive craniectomy in COVID-19 patients presented to our tertiary care hospital. Secondly, to systematically review the literature on the impact of decompressive craniectomy in COVID-19 patients.

Data of all the acute ischemic stroke patients who tested COVID positive during the study period was collected. Among them, patients requiring decompressive craniectomy were included. The demographic, clinical and radiological parameters related to stroke, treatment received, outcome and complications were noted. In addition, data from all case reports and case series published on patients with COVID-19, who developed ischemic stroke and underwent decompression craniectomy was collected and systematically reviewed.

Twenty-seven stroke patients tested positive for COVID-19 infection, out of which, five patients underwent decompression hemicraniectomy in view of neurologic deterioration. The systematic literature yielded 453 abstracts. After reading the full text of 69 articles, 12 studies containing 15 patients finally met our inclusion criteria and were included in the systematic review. The mortality rate was 40% among stroke patients requiring decompressive craniectomy in COVID-19 patients. The mortality rate and functional outcomes of this cohort are comparable to the pre-pandemic period.

Decompressive craniectomy is a life-saving procedure in COVID-19 patients with malignant infarctions similar to patients in the pre-COVID-19 era.