![]() Two trials recruited patients up to 80 years of age, and one trial only included patients above 60 years old. The trials generally selected people with severe strokes with significant impairments who did not have any previous severe illnesses or disabilities. We therefore considered 248 participants who received early surgical decompression and 265 participants who received medical treatment alone after their stroke. We found nine trials with a total of 526 participants, of which 13 participants were not included in the final analysis because they were either lost to follow-up or did not follow the trial instructions. In July 2022, we searched the literature for randomised controlled trials (a type of study where participants are randomly assigned to one of two or more treatment groups) that compared outcomes for stroke patients who were treated with early surgical decompression compared to those who were treated without surgery. We wanted to find out whether the use of surgical decompression is better or worse than standard medical management alone in people who have had a large stroke. Early evidence only studied the use of this technique in younger patients however, more recent studies have begun to address its use in older patients. Recent studies suggest that early use of this treatment after a large stroke can prevent death or disability in survivors. Surgical decompression can help relieve the pressure by creating a large enough hole in the skull and tissue layers around the affected brain (decompressive craniectomy). Sometimes the swelling can be very dramatic, causing a rise in the pressure inside the skull which can lead to the surrounding brain being affected and rapidly progressing to death. Over the following 24 to 48 hours, the damaged brain begins to swell. This blockage prevents the oxygen-carrying blood from supplying the brain, and part of the brain being supplied by this vessel begins to die (infarct). Most strokes are caused by blockage of a blood vessel to the brain (ischaemic stroke), which is a major cause of death and disability worldwide. What is the effect of surgical decompression on death or disability in people who have developed brain swelling after a stroke?
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