This article will review the literature to ascertain the safety and efficacy of hypertonic saline in the treatment of intracranial hypertension. Method: In order to assess the effect of hypertonic saline administered for the treatment of intracranial hypertension on intracranial pressure, a search of PubMed, Ebsco, Scopus, and the Cochrane Library was performed. Search criteria used for this review included adult human studies using brain edema, neurological injury, intracranial hypertension, brain injury, stroke, subarachnoid hemorrhage, and hypertonic saline as search terms yielded 29 studies which were reviewed. Case reports, letters to the editor, languages other than English, and those which included pediatric participants were excluded. Also excluded were studies that involved use of hypertonic saline intraoperatively, studies that focused on the initial resuscitation of traumatic brain injury, those used for purely elective neurosurgical resuscitation of traumatic brain injury, and those used for purely elective neurosurgical patients. Elective neurosurgical patients were excluded since intracranial hypertension is frequently reversed with surgical evacuation of space occupying lesion and not medical therapy. Of the 29 studies that were obtained, 5 were excluded. Two were case studies. One dealt with the intra-operative use of hypertonic saline, and two other studies has foci related to variables other than effect on intracranial hypertension. Results: Whether used as an initial treatment for elevated intracranial pressure or as a rescue therapy for refractory intracranial hypertension, hypertonic saline appears to offer an additional means for lowering intracranial pressure and may provide a bridge to emergent surgical decompression.