This chapter discusses the anaesthetic management of neurosurgery. It begins with general principles of neurosurgery, including management of intracranial pressure. Surgical procedures covered include craniotomy (including awake craniotomy), insertion of ventriculo-peritoneal shunt, evacuation of traumatic intracranial haematoma, pituitary surgery, posterior fossa surgery, and interventional radiology treatment of intracranial vascular lesions (with particular attention to subarachnoid haemorrhage). The management of venous air embolism is described, along with a discussion of the neurological determination of death and organ retrieval from a beating-heart donor.