Herpetic encephalitis is the most common cause of viral encephalitis in our country. Pathological studies show progressive necrosis and edema in specific territories of the brain. The mortality of herpetic encephalitis was reduced from 70% to 20% with the use of intravenous aciclovir in the first three days of illness. However, almost 50% of patients develop a neurological deficit. One of the most important causes of death in herpetic encephalitis is the refractory intracranial hypertension. There are anecdotal reports of patients with refractory intracranial hypertension due to herpetic encephalitis that were treated with decompressive craniectomy with good results. We report a 21 years old female patient with herpetic encephalitis and refractory intracranial hypertension that was successfully treated with a decompressive craniectomy (Rev Méd Chile 2003; 131: 1434-8).