The modern neurosurgical theatre is a vastly different environment to what Victor Horsley and other early neurosurgical pioneers were accustomed to at the turn of the twentieth century. This chapter details the essential equipment used in the modern-day operating theatre including the microscope, endoscope, drills, retractors, diathermy, and haemostatic agents. Commonly used surgical positions are described and illustrated. The history and evolution of stereotactic neurosurgery and neuronavigation is discussed and intraoperative imaging techniques such as X-ray, ultrasound, and magnetic resonance imaging are explained. Intraoperative neurophysiological monitoring techniques are also reviewed including somatosensory evoked potentials, motor evoked potentials, electromyography, and intraoperative cortical mapping.