Background The treatment of cerebral edema and increased intracranial pressure (ICP) has long been a critical component of perioperative care in neurosurgical practice, which is also a vital determinant for the prognosis. Currently, mannitol is the most fundamental agent to control the ICP in clinical practice, and the side effects of the mannitol are increasingly reported. Intensive researches were performed to find a more effective and safe agent for cerebral edema and ICP. Objective The role of hypertonic saline(HS） in controlling increased ICP caused by various neurosurgical diseases will be clarified. Content The review mainly explicates the definite mechanism and related application of HS in neurosurgical diseases. Trend HS has emerged as an alternative to mannitol, and provides a new promising therapy for patients suffering cerebral edema and increased intracranial pressure.