BACKGROUND AND PURPOSE 
Decompressive craniectomy (DC) is beneficial in patients with various diseases including malignant middle cerebral artery (MCA) infarction. In intracerebral hemorrhage (ICH), decompressive craniectomy without hematoma evacuation has only been evaluated in small retrospective studies with a trend towards reduced mortality. However, no randomized trial has ever assessed whether DC is beneficial in ICH. Therefore, the prospective randomized SWITCH trial was initiated in October 2014 to determine whether decompressive surgery and best medical treatment in patients with spontaneous ICH will improve outcome compared to best medical treatment (BMT) only.

METHODS 
SWITCH is an international multi-center randomized trial. 300 patients will be randomized (1:1) into either DC and BMT or BMT alone. Main inclusion criteria are spontaneous ICH of deep origin, NIHSS≥10 and ≤30, GCS>7 and <14 and ICH volume >30 and <100. The primary endpoint is severe disability and mortality, measured with the modified Rankin score 6 months after ictus. 

RESULTS
Recruitment started in October 2014. We currently have 31 sites open in Switzerland and in 5 other European countries. 71 patients were so far successfully randomized into the trial. 

CONCLUSIONS 
After initiation of SWITCH, we could increase the number of open centers to 31 and currently 71 patients have been randomized into the SWITCH trial. Further centers are still highly welcome and we believe that maintaining a high recruitment will be key for successful completion of the trial.   

ClinicalTrials.gov Identifier: NCT02258919

SWISS TRIAL OF INITIAL DECOMPRESSIVE CRANIECTOMY VERSUS BEST MEDICAL TREATMENT OF SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE: A RANDOMIZED TRIAL (SWITCH)

Europe Stroke Organisation Conference