Primary brain tumors (PBTs) refer to the growth of abnormal cells originating in the brain. These tumors account for approximately two percent of all cancers in the adult population of the United States. Patients diagnosed with glioblastoma, one of the most common malignant PBTs, often require treatments in intensive care unit (ICU). Surgical removal of PBTs through craniotomy is often the first-line treatment for many types of brain tumors. ICU admission following major surgery like craniotomy is considered a standard of care in many healthcare systems. ICU provides access to specialized equipment, such as mechanical ventilators, continuous renal replacement therapy machines, continuous electroencephalogram monitoring, and invasive hemodynamic monitoring devices, which might be essential for the care of these patients. Understanding potential complications is essential for healthcare professionals to monitor patients more effectively and guide decision-making for optimal management. Over the years, perceptions of ICU utilization have shifted, raising questions about whether ICU admission is always the right choice for patients who have undergone brain surgery. Traditional scoring systems may not always demonstrate the necessity of ICU care for patients undergoing elective craniotomy for PBTs. Further research is needed to identify the most effective strategies for optimizing patient care, determining the need for ICU care in specific cases, and minimizing costs in neurosurgery.