Background: The present study was conducted for assessing the outcome following decompressive craniectomy for malignant middle cerebral artery infarction.Materials &Methods: A total of 50 patients with presence of malignant infarct [space-occupying total infarction in the region of the MCA or both the MCA and the anterior cerebral artery (ACA)] and who received a decompressive craniectomy were enrolled. Another set of 50 patients who received medical treatment were enrolled as a conservative care group. All patients were treated within 48 hours of the stroke event. For the craniectomy group, the principal surgical technique was a large decompressive craniectomy with duroplasty. Follow-up was done and clinical status of all the patients was evaluated and compared using NIHSS (National Institutes of Health Stroke Scale) scoring. Results: Non-significant results were obtained while comparing the NIHSS score among the patients of the two study groups. Favorable outcome was seen in 30 percent of the patients of the conservative care group and in 60 percent of the patients of the craniectomy group (p-value < 0.05). Mortality was seen in 42 percent of the patients of the conservative care group and in 28 percent of the patients of the craniectomy group (p-value < 0.05).Conclusion: In cases of malignant MCA infarction, early decompressive hemicraniectomy has been shown to improve functional prognosis.