Decompressive Hemicraniectomy in Intracerebral Hemorrhage

Inclusion Criteria: * Written informed consent of the patient or of patient's next of kin plus consent of an independent physician if patient is unable to consent before randomization * Acute stroke syndrome due to a spontaneous ICH, defined as the sudden occurrence of bleeding into the parenchyma of the basal ganglia and/or thalamus that may extend into the ventricles and into the cerebral lobes, and into the subarachnoid space, confirmed by clinical history and imaging * Age: ≥18 to ≤75 years * Glasgow coma scale (GCS) \<14 and \>7 * Neurological deficit with a NIHSS score of ≥10 and ≤30 * Able to be randomly assigned to surgical treatment within 66 hours after ictus * Surgery performed not later than 6 hours after randomization * Volume of hematoma ≥30 ml and ≤100 ml * Stable clot volume * International normalized ratio (INR) \<1.5, thrombocytes \>100 T/ml Exclusion Criteria * ICH due to known or suspected structural abnormality in the brain (e.g., intracranial aneurysm, brain arteriovenous malformation, brain tumor) or brain trauma, or previous stroke thrombolysis * Cerebellar or brainstem hemorrhage * Exclusive lobar hemorrhage * Known advanced dementia or significant pre-stroke disability * Concomitant medical illness that would interfere with outcome assessment and follow-up * Randomization not possible within 66 hours after ictus * Pregnancy * Prior major brain surgery within \<6 month or prior DC * Foreseeable difficulties in follow-up due to geographic reasons * …