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Researchers report a preplanned pooled analysis of three European randomized controlled trials (the French DECIMAL, German DESTINY, and Dutch HAMLET trials) that compared early decompressive surgery with conservative treatment for malignant middle cerebral artery (MCA) infarction. A total of 93 patients fulfilled the inclusion criteria for the pooled analysis: age 18 through 60, NIH Stroke Scale (NIHSS) score greater than 15, decrease in the level of consciousness to a 1 or greater on item 1a on the NIHSS, at least 50% of the MCA territory infarct seen on CT or infarct volume >145 cm3 on diffusion-weighted MRI, and treatment within 48 hours after onset of symptoms. The primary outcome was modified Rankin Scale (mRS) score at 1 year; favorab…