The study objective is to evaluate the effectiveness of various methods of surgical treatment of malignant cerebellar infarction.Materials and methods. There were 47 patients with malignant cerebellar infarction retrospectively analyzed in this study. The group 1 included all patients who underwent surgical treatment (n = 31), the group 2 included all patients who underwent conservative treatment (n = 16). In the group 1, 15 patients underwent isolated ventriculostomy, 4 – posterior fossa decompression (PFD), 14 – combination of ventriculostomy and PFD. The criteria of efficacy of surgery were: restoration of consciousness, restoration of forth ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow outcome scale.Results. The recovery of consciousness level was observed in 7 out of 15 patients after isolated ventriculostomy on average 13 day; the efficacy was 47 %. Four patients underwent only PFD. Among them 2 patients needed additional external ventricular drainage installation as 2nd operation. The efficacy was 50 %. After PFD with simultaneous ventriculostomy the recovery of consciousness was observed on 4 day in 11 out of patients. The efficacy was 79 %. Combined ventriculostomy and PFD were 32 % more effective than ventriculostomy alone, and 29 % more effective than PFD alone.Conclusion. In patients with malignant cerebellar infarction with a decrease in consciousness and signs of brainstem compression, ventriculostomy with PFD are advisable, because isolated ventriculostomy does not always provide a necessary effect in decompensation of dislocation syndrome.