The maintenance of airway is essential for management of the neurosurgical patients. The patients often require prolonged intubation or tracheostomy. The choice of method to manage the airway is still controversial. So, we reviewed 92 neurosurgical patients who had early tracheostomies retrospectively. In this series, the results were as follows. 1) The mental status at the admission might be an indicator of early tracheostomy. Most cases required prolonged period for airway management. Therefore, early tracheostomy should be considered because this could prevent a lot of complications caused by the prolonged translaryngeal intubation. 2) The most ideal indication of early tracheostomy was the airway obstruction caused by neurologic deficit. 3) The acid-base imbalance and cerebral hypoxia in neurosurgical patients might be improved by early tracheostomy. 4) Early tracheostomy is a safe surgical procedure and represents lower complication rate than translaryngeal intubation at the neurosurgical patients.