Background: There are inconsistencies regarding the role of decompressive craniectomy (DC) in malignant middle cerebral artery (MCA) infarction. Aim of the work: The aim of this retrospective study is to describe the early postoperative outcomes of patients with malignant MCA infarction who underwent DC. Subjects and Methods: Data of patients who present with malignant MCA infarction and underwent DC from January 2014 to December 2018 were reviewed. The postoperative outcomes were assessed in all patients which included mortality rates, hospital stay, Modified Rankin Scale (mRS), and the incidence of postoperative complications. Results: The present study included 23 cases who underwent DC. The majority of patients had right-sided stroke (74%) and four patients had severe aphasia. The mean hospital stay of the included patients was 14.6 ±5.7 years and the mortality rate was 39.1%. Four patients had mRS class 3 (17.4%) and five patients had mRS class 4 (21.7%). Twenty-one patients (91.3%) experienced early postoperative complications and four patients (17.4%) experienced late postoperative complications. Conclusions: In conclusion, decompressive craniotomy has a relatively low mortality rate and improves the functional outcomes in patients with malignant MCA infarction. Larger trials with longer follow-up periods are warranted to help with clinical decision making in these patients.