Elevated intracranial pressure is a serious complication in the early phase after brain infarction. The most frequent cause of the elevated pressure is oedema following an infarction in the territory of the middle cerebral artery. Non-surgical treatment is inadequate in many of the patients. Although anecdotal, several reports concerning neurosurgical treatment seem to be optimistic. We think that such treatment could be given to selected young patients with large hemispheric infarctions and cerebral oedema.