Intracranial pressure after aneurysmal subarachnoid hemorrhage: time to revisit.

Long since the days of pneumoencephalography, it has been known that massive aneurysmal subarachnoid hemorrhage (aSAH) may result in significant elevation in intracranial pressure (ICP) which can be fatal without prompt treatment and can trigger a vicious cycle of low cerebral perfusion induced ischemia in turn causing further ICP elevation [1]. Management of aSAH has evolved significantly during recent times with increasing number of patients, especially poor-grade patients receiving endovascular treatment [2]. Surgical and endovascular treatments of cerebral aneurysms create significantly different pathophysiologic milieu in the cranial vault [3], and therefore, call for a need to revisit.