Background: A severe kind of ischemic stroke known as massive hemispheric infarction affects either the entire or most of the middle cerebral artery (MCA) and is distinguished by the emergence of potentially fatal cerebral edema. A death rate of up to 80% has been linked to this type of space-occupying edema. In acute ischemic stroke patients, decompressive craniectomy (DC) is a surgery used to treat brain herniation and deadly progressive edema. Objectives: This work aimed to study the limits and prognostic factors for surgical decompression in managing patients with massive hemispheric infarction. Patients and methods: This prospective study included 17 patients with massive hemispheric infarction who were admitted and treated at the Neurosurgical Departments of Menoufia University Hospital from February 2022 to February 2024. Results:  There were no significant differences in the relation between death after treatment and Glasgow Coma Scale (GCS) (Before treatment, after one day and 6 M), MRS (before treatment), and time of surgery after the onset of symptoms/H (P>0.05). Also, NIHSS Score, mRS after 1 M and 6 M were significantly increased among death patients after treatment (P<0.05). Conclusions: Decompressive craniotomy can reduce the mortality rate in patients with massive hemispheric infarction, provided that it is done as early as possible from the onset of symptoms. The higher the GCS the better is the outcome.