treatment. The Decompressive hemicraniectomy at a earlier time significantly reduces the mortality. Materials & Methods: About 812 patients who underwent any type of craniectomy from May 2016 to May 2018, at the Institute of Neurosurgery, Madras Medical College, Chennai, TamilNadu, India were retrospectively studied. Various pre-operative prognostic factors were studied. Observation: Post operatively, the outcomes were assessed by univariate and multi variate analysis. Results: History of Diabetes, hypertension, Myocardial infarction, midline shift more than 10mm, involvement of dominant hemisphere carried grave post operative prognosis.