A prerequisite for improving the outcomes of aneurysmal subarachnoid hemorrhage (SAH) is to stabilize the general condition of the patient and perform aneurysmal obliteration as soon as possible. Surgical modalities and strategies should be selected to minimize treatment complications, including additional brain damage. Moreover, postoperative management is required to stabilize the intracranial environment, including the intracranial pressure, and prevent secondary brain injury. To further improve the outcomes of SAH, it is necessary not only to improve surgical or endovascular treatment outcomes but also to develop new therapies for early brain injury and delayed cerebral ischemia. Currently, several phase 3 trials aimed at preventing secondary brain injury are being conducted, and the results are expected to be available shortly.