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Ege Üniversitesi Tıp Fakültesi, Nöroşirürji Anabilim Dalı, Bornova, İzmir Acute massive brain swelling after cerebral infarction is not common. For patients experiencing this uncommon, but lethal phenomena, however, few management options are available to the clinician. Nonoperative therapy using hyperventilation, osmotic agents must be instituted soon after the diagnosis is made. Decompressive craniectomy for acute brain stem compression either from cerebral or cerebellar infarction is life saving in cases when medical therapy is insufficent. We have managed 14 patients (8 men and 6 women with an avarage age of 57 years) with acute brain stem compression due to cerebral and cerebellar infarction. All were treated with decompressive craniectomy after conventional medical therapy failed to achieve a response. All patients survived except 4. At the 2 year follow up examination, most of them (7 of 10) are able to walk and do their activities without help. Anahtar Kelimeler : Cerebral infarction, cerebellar infarction, craniectomy