Space Flap for Cerebral Protection Following Decompressive Hemicraniectomy for Stroke

Inclusion Criteria: * Age between 18 and 65 years * Decompressive hemi-craniectomy planed for\*: * Impairment of consciousness or progressive reduction of consciousness and * Mass effect on brain imaging (oedema exceeding 50% of the MCA territory and midline shift), and * Exclusion of other causes of impaired consciousness (e.g. hypoperfusion, hypotension, cerebral reinfarction, epileptic seizures * Informed consent from relatives Exclusion Criteria: * Bilateral, nonreactive, not drug-induced pupillary dilation, associated with coma\* * Simultaneous presence of all four of the following unfavorable prognostic factors: \* * Age 50 years * Involvement of additional vascular territories * Unilateral pupillary dilation * GCS\<8 * Severe comorbidity (severe heart failure or myocardial infarction, incurable neoplasia, etc. \* * Refusal by the patient of this treatment, as known from current interaction with the patient, from existing written documents or related by the patient's proxies. \* * Known pulmonary or cranial infection * Any coagulopathy * Rapid neurological decline prohibiting the extra time needed for space flab production (10min) * Pregnancy