title: Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial.
abstract: OBJECTIVE
  We assessed whether the effects of surgical decompression for space-occupying hemispheric infarction, observed at 1 year, are sustained at 3 years.
  
  
  METHODS
  Patients with space-occupying hemispheric infarction, who were enrolled in the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial within 4 days after stroke onset, were followed up at 3 years. Outcome measures included functional outcome (modified Rankin Scale), death, quality of life, and place of residence. Poor functional outcome was defined as modified Rankin Scale >3.
  
  
  RESULTS
  Of 64 included patients, 32 were randomized to decompressive surgery and 32 to best medical treatment. Just as at 1 year, surgery had no effect on the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% confidence interval, -21 to 22), but it reduced case fatality (absolute risk reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated patients and 8 controls lived at home (absolute risk reduction, 27%; 95% confidence interval, 4-50). Quality of life improved between 1 and 3 years in patients treated with surgery.
  
  
  CONCLUSIONS
  In patients with space-occupying hemispheric infarction, the effects of decompressive surgery on case fatality and functional outcome observed at 1 year are sustained at 3 years.
  
  
  BACKGROUND
  http://www.controlled-trials.com. Unique identifier: ISRCTN94237756.
authors.affiliation: Department of Neurology and Neurosurgery, UMC Utrecht Stroke Center, Utrecht, The Netherlands. m.geurts-2@umcutrecht.nl
authors.forename: Marjolein
authors.initials: M
authors.lastname: Geurts
authors.forename: H Bart
authors.initials: HB
authors.lastname: van der Worp
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: G Johan
authors.initials: GJ
authors.lastname: Amelink
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Jeannette
authors.initials: J
authors.lastname: Hofmeijer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000601:surgery*; D019299:Decompression, Surgical / Q000401:mortality / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000592:standards*; D011788:Quality of Life / Q000523:psychology*; D012306:Risk; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: decompressive surgery; hemicraniectomy; malignant cerebral infarction; space-occupying hemispheric infarction