Stroke is rare in children, however, a common cause of neurological disease, and it is a major cause of death ranks in the top ten in pediatric perior112. Documented incidence has been reported as 2.5-8/100000 children/year 3,4.

Medical treatment includes maintaining cerebral perfusion pressure with hyperventilation and ownotherapy, barbiturate and in case of thrombotic ischemia, thrombolytic procedure and anticoagulant therapy. However, if medical treatment failed and there is raise of intracranial pressure (ICP) and deterioration of patient conscious level, alternative treatments such as surgical decompression can be mandatory.

The common rationale of decompressive craniectomy with or without duroplasty is to let the volume expansion of the swelled up brain to extracranial space via removed skull flap and prevent cerebral herniation and secondary damage of brain perenchyme.

In case of traumatic brain injury, decompressive craniectomy for young adult patient has been reporteds. However, there has not been a definite evidence or standard guideline for decompressive cranicctomy for patient with non-traumatic acute stroke with uncontrolled refractory high intracranial pressure.

Two young adult patient were treated with decompressive hemicranioctomy with duroplasty for non-traumatic and refractory intracranial hypertension after unilateral hemispheric stroke.

Our cases was caused by ischemic stroke in Left MCA territory. Conventional laboratory results were within normal range. Al the time of operation, The patients had a GCS score <8 and both the patients had unilateral mydriasis. Surgical decompressive hemicraniectomy were performed in 14 hour & 18 hours respectively and the ICP of our patients were improved following surgery (clinical monitoring).

There were no surgical complications, such as cerebrospinal fluid leakage, intracranial haematoma or wound infection even after cranioplasiy.

The mean follow-up period was 36 months. GCS and Nurologic deficit had been measured to evaluate postoperative neurological outcome. Based on the regular follow up GCS scats. 2 patients had shown satisfactory recoveries. Both of them showed good recoveries with some neurological deficits. And none of them revealed severe disability or death.