The document discusses perioperative neurosurgical critical care. It describes a clinical case of a patient returning to the ICU after decompressive craniectomy for malignant MCA infarction who faces challenges from medical comorbidities and surgery. It then discusses goals of postoperative neurosurgical care including emergence from anesthesia, hemodynamic and respiratory status optimization, and complication management. Specific complications are reviewed for various neurosurgeries like craniotomies, pituitary surgery, and carotid endarterectomy.