Inclusion criteria: |
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- Clinical deficits suggestive of infarction in the territory of the MCA with a NIHSS score ≥16
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- Decrease in the level of consciousness to a score of ≥1 on item 1a of the NIHSS
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- Signs on brain CT of an infarct of ≥50 percent of the MCA territory, with or without additional infarction in the territory of the ipsilateral anterior or posterior cerebral artery, or infarct volume >145 cm3 on diffusion-weighted brain MRI
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- Time from symptom onset to start of surgical decompression <48 hours
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- Written informed consent by the patient or a legal representative
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Exclusion criteria: |
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- Both pupils fixed and dilated
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- Contralateral ischemia or other brain lesion that could affect outcome
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- Space-occupying hemorrhagic transformation of the infarct
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- Other serious illness that could affect outcome
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- Known coagulopathy or systemic bleeding disorder
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- Contraindication for anesthesia
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