El infarto maligno de la arteria cerebral media representa entre 5 a 10% de los pacientes con enfermedad vascular cerebral isquemica, conllevando una alta mortalidad y discapacidad funcional. Para su tratamiento ha sido utilizada la craniectomia descompresiva en un grupo selecto de pacientes. En este escrito es revisada la literatura referente a la efectividad de este procedimiento. Adicionalmente, son recopiladas las recomendaciones basadas en la evidencia para la eleccion meticulosa y racional de los potenciales candidatos a esta cirugia. Rev.cienc.biomed.2011; 2 (2): 281- 288 PALABRAS CLAVES Craniectomia descompresiva. Cirugia. Hipertension intracraneal. Herniacion. Edema cerebral. Desviacion de linea media. SUMMARY Malignant middle cerebral artery infarction represents a 5 to 10% of patients with ischemic stroke, leading to high mortality and disability. For its treatment, decompressive craniectomy has been utilized in a selected group of patients. Decompressive craniectomy is a neurosurgical procedure that has been used in the treatment of a select group of patients. In this paper we review the literature on the effectiveness of this procedure. Additionally, evidence-based recommendations for the careful and rational selection of potential candidates for this surgery are also exposed. Rev.cienc.biomed.2011; 2 (2): 281-288