Objective To explore the efficacy and safety of minimally invasive aspiration of necrotic brain tissue combined with lateral ventricular catheter drainage for patients with malignant middle cerebral artery infarction aged between 60 and 80. Methods We collected 46 patients （60-80 years old） with malignant middle cerebral artery infarction， who were treated in Yancheng No. 1 People's Hospital from January 2018 to December 2019. Among them， 21 patients who were treated with invasive aspiration of necrotic brain tissue plus lateral ventricular catheter drainage were assigned as the aspiration group， and 25 patients who were treated conservatively were assigned as the conservative group. The short-term and long-term efficacy and incidence of complications were compared between the two groups. Results The 1-month mortality rates of the conservative group and the aspiration group were 68.0%（17/25） and 9.5%（2/21）， respectively. The incidence of early cerebral hernia within 1 week was 68.0%（17/25） and 14.3%（3/21）， respectively. The differences were statistically significant （P＜ 0.001）. There was no statistical difference in the incidence of intracranial hematoma and intracranial infection between the two groups （P ＞ 0.05）. The 6-month mortality rate of the conservative group and the aspiration group were 76.0% and 14.3%， respectively. The rates of the conservative group and the aspiration group for a score of 0 to 4 on the modified Rankin Scale （mRS） were 12.0%（3/25） and 61.9%（13/21）， respectively. The differences were statistically significant （P＜ 0.001）. The rates of the conservative group and the aspiration group for a score of 0 to 3 on the mRS were 4.0%（1/25） and 23.8%（5/21）， respectively， with no statistically significant difference （P＞ 0.05）. Conclusions The study initially showed that minimally invasive aspiration of necrotic brain tissue plus lateral ventricular catheter drainage can reduce the mortality and improve the prognosis of elderly patients with malignant middle cerebral artery infarction， and it is safe.