Economic and Clinical Impact of Craniotomy and Decompressive Craniectomy in Low- and Middle-Income Countries: A Systematic Review Publisher



Fahim F ; Yousefi H ; Mastani RG ; Hemmati M ; Nikbakhtamirabad O
Source: Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Published:2026

Abstract

Background: Decompressive craniectomy (DC) and craniotomy are important procedures in events including traumatic brain injury (TBI), rise of intracranial pressure (ICP), and some arterial infarction. However, these surgeries are crucial in the treatment of patients; they can have a severe economic burden, especially in low and middle-income countries (LMICs). Objective: Clearly, the costs of DC and craniotomy can affect every aspect of patients’ lives, so it would be valuable to evaluate the exact costs of these procedures in LMICs and determine the long-term outcomes in patients. Methods: We designed a systematic review and search for related articles in databases including MEDLINE/PubMed, Scopus, Web of Science, and Embase. By the primary search with related keywords, we found 454 articles that, after duplications were removed in EndNote 2025, we imported all of the articles to RAYYAN, and the screening was done by three people. At last, we achieved 15 final articles that were all COHORT. This study followed PRISMA 2020, and it was registered in PROSPERO with the registration ID of CRD42025112655. Result: 15 articles were related to our purpose. there were 11 articles in the craniotomy was their first choice, and 4 of them included DC. The survival rate was in the range of 31% to 100%. Also economic burden was very closely related to the national income levels. Conclusion: In summary, DC and craniotomy are effective procedures that increase the survival rate in patients, but also have an economic burden in LMICs. Although costs were varied based on the country and the hospital, expanding health insurance can decrease the economic burden and be helpful for patients. © 2026