Critical care management of a patient with aneurysmal subarachnoid hemorrhage (aSAH) is quite challenging because it involves not only the brain but also the other major organ systems of the body. The secondary effects of a ruptured aneurysm are life-threatening and are difficult to treat. The existing evidence on the neurocritical care management of aSAH is not very clear and gives rise to many controversies. This chapter focuses on the major controversies, including timing of aneurysm repair; coiling versus clipping as a modality for aneurysm repair; use of antifibrinolytic therapy in acute aSAH; blood pressure goals before aneurysm treatment; vasospasm and delayed cerebral ischemia (DCI) prevention and treatment strategies; and pressure vs flow augmentation. The existing literature supports early aneurysm repair as soon as feasible. Coiling is favored in the posterior circulation, and clipping is preferred in a large hematoma. For good-grade and anterior circulation, both techniques are equally good, but coiling may have a better functional outcome at 1 year but not at 5 years. For blister aneurysms, flow diverters appear to be an appealing choice. Routine use of antifibrinolytics is not recommended; prophylactic blood pressure augmentation is not recommended, while for the treatment of DCI, hemodynamic augmentation needs to be individualized.