Methods
stroke, DEcompressive, infratentorial infarction, malignant INfarction, hemispheric syndrome, infarction
STROKE, INFARCTION
Between January 2010 and July 2016 patients with large ischemic infarction were prospectively included into the DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY—Registry (DESTINY-R) study in 30 neurological and neurosurgical departments in Germany and Austria.A detailed description of the study design has been published previously [For this analysis patients who fulfilled the following inclusion criteria were selected from the complete study cohort: (1) ischemic infarction of at least 50% of the middle cerebral artery territory confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) with corresponding clinical signs of a severe hemispheric syndrome, with or without additional infarction of the ipsilateral anterior or posterior cerebral artery territory, (2) hemicraniectomy performed according to the decision of the treating physician independent of study participation, (3) available postoperative imaging data measuring hemicraniectomy diameter, and (4) completed follow-up assessment of functional outcome conducted after 12 months. Patients with concomitant acute contralateral and/or infratentorial infarction or additional acute traumatic brain injury were excluded. The timing of hemicraniectomy and choice of the surgical technique (including the diameter of the bone flap, type of duraplasty) were left to the discretion of the treating neurosurgeon with a reference to the current guidelines [After study inclusion, sociodemographic factors, clinical parameters (stroke severity on admission, level of consciousness on admission and before neurosurgery), pre-morbid functional status, vascular risk factors as well as surgical and medical treatment data were documented in a case report form [