Cerebral arterial vasospasm continues to be a major secondary medical complication of aneurysmal subarachnoid hemorrhage. Despite hypervolemic hemodilution, arterial hypertension, and pharmacological therapy, morbidity and mortality due to vasospasm remain high. The authors discuss a patient with vasospasm who did not respond to traditional medical therapy and who underwent intra-arterial papaverine infusions while being monitored with transcranial cerebral oximetry. Oximetry during the procedure revealed significant improvements in brain regional saturation of oxygen, with the relief of vasospasm that correlated with clinical improvements in the patient's neurological status. Transcranial cerebral oximetry was used to monitor regional oxygen saturation throughout the angiographic and interventional procedures, providing continuous, real-time, clinically relevant information about the effects of vasospasm and its treatment.