Introduction: ischemic stroke is an acute brain injury occurs as a result of an obstruction of a blood 
vessel supplying a part of the brain. Aim of the work : This study aims to evaluate the rule of surgical 
decompression in management of brain infarction. Patients and Methods: The study was performed 
at the Department of Neurosurgery of El Minia university Hospital. Results: According to our study 
that performed on 20 patient of massive brain infarction who underwent surgical decompression in 
our department the following are the results. Discussion: Massive brain infarction including 
malignant MCA infarction or massive cerebellar infarction have been found to result in high 
morbidity and mortality. Summary: 4-Any patient with massive cerebellar infarction with 
progressive deterioration in the conscious level despite of conservative treatment should undergo 
suboccipital decompressive craniectomy, excesion of the infarct tissues and duroplasty.