Neurologymiddle twist
A 48-year-old man has a large right middle cerebral artery infarction despite reperfusion treatment. Twenty-four hours later he becomes increasingly drowsy, develops a left hemiparesis and has a right dilated sluggish pupil. Repeat CT shows extensive hemispheric swelling with 8 mm of midline shift and early compression of the lateral ventricle. Which one of the following is the most appropriate definitive treatment?