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Background and purpose: Both hypothermia and Decompressive craniectomy (DC) have been shown to reduce ischemic injury in experimental middle cerebral artery occlusion (MCAO). This study was designed to evaluate the effect of delayed combination of DC and Local Hypothermia (LH) on infarct size, neurological outcome and blood brain barrier (BBB) disruption in a rat model of stroke. Material and Methods: MCAO was induced in 36 Wistar rats assigned to three groups of control, Decompressive Craniectomy (DC) and combination of Hypothermia and Craniectomy (HC). Infarct size and BBB disruption were measured 48 hour after ischemia insult. Neurological deficits were assessed at 24 and 48 hours after stroke using sticky tape test, hanging-wire test and Bederson’s scoring system. BBB disruption was measured by Evans blue dye leakage. Results: Compared to the control group, infarct size reduced significantly in DC and HC groups (P<0.001), however, combination therapy was more neuroprotective compared to craniectomy alone (P<0.01). Compared to the control group, BBB disruption was significantly reduced in DC (P<0.05) and HC (P<0.01).While compared to the control group sticky tape test (P<0.05 at 24 h P<0.001 at 48 h) and hanging-wire test (P<0.05) showed better behavioral performance only in HC, and Bederson test showed improved behavioral functions of HC animals (P<0.01). At the same time neurological deficits also decreased in HC group (P<0.05 at 24 h P<0.01 at 48 h) compared to the DC group. Conclusion: According to this study although both delayed local hypothermia and craniectomy are protective after stoke, combination therapy of them is more neuroprotective than given alone.