Background: In malignant cerebral venous thrombosis (CVT) patients, although endovascular thrombectomy usually can open the occluded dural sinuses with full of thrombus, it is impossible to recanalize the ample thrombosed cortical and deep cerebral draining veins in short time, which will still cause severe brain edema and refractory intracranial hypertension. Therapeutic hypothermia is an effective measure to control refractory intracranial hypertension from cerebral injury. So these patients may benefit from endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy. Methods: Prospective case series. We included all consecutive patients who had a malignant CVT as defined: decreased consciousness, straight sinus thrombosis, or large space-occupying lesions from January, 2014 to June, 2016. These patients would first receive endovascular thrombectomy and thrombolysis to open the occluded thrombosed dural sinuses, then assigned to therapeutic hypothermia (33-35°C) for 3-5 days, and decompressive hemicraniectomy (only with cerebral herniation). Outcome was assessed at 12 months after operation with the modified Rankin Scale (mRS). Results: Fifteen patients (10 women) with a median age of 32 years (range 19-54 years) were included. Before surgery 9 patients had GCS < 9, 10 patients had normal pupils, 5 patients who had a unilaterally fixed and dilated pupil underwent unilateral decompressive hemicraniectomy, 12 patients had space-occupying intracranial hemorrhagic infarcts, and 2 patients had straight sinus thrombosis. No patients except one (with minor increase) had increased cerebral hemorrhage after endovascular thrombectomy. 10 patients recovered without disability at 12 months (mRS 0-1). Three patients had some residual handicap (mRS 2). One patient was moderate handicapped (mRS 3). One patient died from progressive cerebral edema due to the ample thrombosed cortical cerebral draining veins even after surgical decompression in short time. Conclusion: Endovascular treatment combined with therapeutic hypothermia and decompressive hemicraniectomy is safe and effective for malignant CVT, and even allow a good functional outcome in patients with cerebral herniation.