Percutaneous dilatational tracheotomy (PDT), characterized by its minimal invasiveness and high safety profile, has become the mainstream technique for tracheotomy. To achieve adequate tracheal exposure, the procedure requires positioning the patient with shoulder elevation and neck hyperextension. However, this specific maneuver may increase intracranial pressure (ICP), which could potentially lead to adverse effects on long-term neurological outcomes. This case report presents the perioperative ICP monitoring data of a brain-death patient who underwent PDT approximately two weeks after acute brain injury. Our observations indicated that ICP remained persistently elevated by approximately 3-5 mmHg above the baseline from the establishment of the surgical position until the patient was returned to the initial supine position. Although this ICP elevation did not appear to directly influence the outcome in this particular case (given the patient's brain-death status), it nonetheless suggests a potential compromise to optimal ICP management. While early tracheostomy offers benefits such as enhanced patient comfort and reduced sedation requirements, balancing the timing of PDT in neurocritically ill patients against the risk of procedure-related ICP elevation and secondary neurological injury warrants further investigation through large-scale clinical studies.