A Space-expanding Shield in Decompressive Hemicraniectomy for Stroke

Inclusion Criteria: * Patients with malignant infarction of the middle cerebral artery identified by MRI including diffusion-weighted imaging or CT including perfusion imaging - fulfilling the European guidelines for decompressive hemicraniectomy (DCE) for stroke * ≥ 18 and \< 70 years of age * Availability of consent from a next of kin and from the patient represented by an independent physician Exclusion Criteria: * Hyperacute need for DCE due to rapid neurological decline * Contraindications to the use of polymethyl-methacrylate (PMMA), e.g., known hypersensitivity, allergy * Known gentamicin allergy * Pregnancy and active breast-feeding * Patients with a former history of DCE and/or CP * Active pulmonary or cranial infection * Known coagulopathy independent of medication