Acute massive cerebral infarction is a type of ischemic cerebrovascular disease, usually an acute massive ischemic infarction of one cerebral hemisphere caused by a sudden occlusion of the internal carotid artery or middle cerebral artery on one side. Cerebral embolism is most commonly caused by a blood clot that breaks off from the heart and runs with the blood flow into the cerebral arteries. Emboli can also come from sclerotic plaque dislodged from the internal carotid artery, or, in a few cases, from amniotic fluid from women in labor, fat from fractures, and so on. The embolus can enter the internal cerebral artery directly along the blood flow and cause brain tissue necrosis in the blood supply area of the artery. Common primary diseases include: wind heart disease, atrial fibrillation, cerebral arteriosclerosis, hypertension, diabetes mellitus, etc. Occlusion of the internal carotid artery or middle cerebral artery rapidly causes large areas of brain tissue with impaired blood and oxygen supply, resulting in brain cell necrosis. Irreversible death of brain tissue with no blood supply at all can occur within 6 minutes, while partially ischemic brain tissue may survive for about 3 hours, and the necrotic brain tissue swells rapidly. Since the adult skull is an almost closed cavity with limited volume, especially in younger patients, the brain tissue is more plump and the volume of the cranial cavity that can be utilized is relatively smaller. The swollen brain tissue has no outlet and has to compress the surrounding healthy brain tissue, leading to secondary degeneration and necrosis of brain cells, including the brainstem “life center” in charge of breathing and heartbeat “This leads to secondary degeneration and necrosis of brain cells, including the “life center” of the brainstem, which is responsible for breathing and heartbeat. The mortality rate of patients can be as high as 80% or more, and death usually occurs within 3-5 days after the onset of the disease. If the swollen brain tissue is given a “way out” in time, the compressed brain tissue may return to normal. This “way out” is commonly known as a “skylight” in the skull, medically known as “decompression of the bone flap”. Through the surgical method, the neurosurgeon removes part of the skull, removes part of the necrotic brain tissue, increases the volume of the cranial cavity, relieves the intracranial pressure, promotes the blood return, causes the blood vessels in the ischemic area and the surrounding compressed brain tissue to expand, improves the blood supply near the infarct, prevents the expansion of the ischemic area, and promotes the recovery of brain function, which can greatly reduce the death rate and the degree of disability. However, clinically, we often encounter patients’ families hesitating and delaying the timing of surgery. According to clinical studies, the mortality rate of non-surgical (conservative) treatment of acute massive cerebral infarction is over 50%, and even if the patient survives, the proportion of severe disability is very large. In contrast, the mortality rate of patients undergoing surgery is only 20%, and most deaths are in older patients with other organ insufficiencies. If acute massive cerebral infarction is a death sentence for patients, debulking decompression is a “window to life”. The operation does involve various risks, but at least it brings hope for life.