Response to Drs. Lahiri and Lyden

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We thank Drs. Lahiri and Lyden for their valuable comments regarding the benefit of hemicraniectomy in patients over the age of 60 years. As the authors mentioned, there was a trend toward higher odds of favorable outcome (modified Rankin Scale scores of 0-3) among those randomized to hemicraniectomy compared with conservative treatment in trials that permitted recruitment of patients aged 60 years or older (303 subjects analyzed; odds ratio 1.87, 95% confidence interval .91-3.86, P = .09). We agree that the data did not support a significant benefit but only a trend toward higher rates of favorable outcomes.

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