【Abstract】 Objective To investigate the application value of invasive intracranial pressure (ICP) monitoring in the surgical treatment of large area cerebral infarction and provide a theoretical basis for the surgical treatment. Methods The clinical data of 140 patients with largearea cerebral infarction treated in our hospital from June 2015 to June 2017 were retrospectively analyzed. 70 patients in the control group were given CT/MRI examinations, while 70 patients in the observation group were given invasive ICP monitoring. Then the therapeutic efficacy, NIHSS score, Barthel index and Glasgow Coma Scale (GCS) score were compared between the two groups. The operation time, length of hospital stay, mannitol dosage and complications during followup were recorded. Results The proportion of good, moderate disability, severe disability, plant survival and death among two groups had no difference (P＜005). The Barthel index, NIHSS score, and GCS score were significant difference between groups (P＜005). While the operation time showed no significant difference between groups (P＞005). The length of hospital stay, the average dosage of mannitol in the observation group were significantly lower than those in the control group (P＜005). The incidence of pulmonary infection and electrolyte disturbance in the observation group was significantly lower than that in the control group (P＜005). Conclusion The invasive ICP monitoring is an effective way to judge the operation time and control the mannitol dosage with shorter hospital stay and fewer complications for patients with large area cerebral infarction.