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Stroke is the second most common cause of death and morbidity in the world [1]. It is considered malignant when the presence of edema leads to increased intracranial pressure and supratentorial herniation [2]. Malignant stroke occurs in 1-10% of patients with a supratentorial ischemic stroke [3] and it is associated with 80% mortality if left untreated [4]. For this condition, either conservative medical management or decompressive surgery may be decided, but the latter strategy has proven to be more effective and life-saving [5].