title: Decompressive surgery for malignant middle cerebral artery infarcts: the results of randomized trials can be reproduced in daily practice.
abstract: BACKGROUND
  In clinical randomized controlled trials (RCTs), decompressive surgery (DS) for malignant middle cerebral artery (MMCA) infarcts leads to a 50% absolute risk reduction in mortality, and improves the 1-year functional outcome. The reproducibility of these results in routine practice has never been evaluated. The purpose of this study was to test the hypothesis that the results of DS for MMCA in practice are similar to those observed in the surgical group of RCTs.
  
  
  METHODS
  We prospectively included the first 31 patients who underwent DS for MMCA. They were screened based on similar criteria as in the meta-analysis. The primary outcome was a modified Rankin Scale (mRS) score of ≤4, and secondary outcomes were mRS of ≤3 and death at 1 year.
  
  
  RESULTS
  Thirty-one patients underwent DS for MMCA. The 1-year mRS was ≤4 in 22 patients (71.0%) and ≤3 in 16 (51.6%). Seven patients died (22.6%).
  
  
  CONCLUSIONS
  This observational study showed that DS for MMCA in a center without previous experience provides similar results as those obtained in the surgical arm of RCTs.
authors: Department of Neurology, University Lille Nord de France, Lille, France. christian.lucas@chru-lille.fr
authors: Christian
authors: C
authors: Lucas
authors: Laurent
authors: L
authors: Thines
authors: Frédéric
authors: F
authors: Dumont
authors: Xavier
authors: X
authors: Leclerc
authors: Bernard
authors: B
authors: Riegel
authors: Charlotte
authors: C
authors: Cordonnier
authors: François
authors: F
authors: Fourrier
authors: Hilde
authors: H
authors: Hénon
authors: Marc
authors: M
authors: Rousseaux
authors: Didier
authors: D
authors: Leys
authors: Jean-Paul
authors: JP
authors: Lejeune
mesh_terms: D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult