Space-occupying lesions such as tumours, intracranial haematomas and abscesses are the most common indications for supratentorial surgery. Anaesthesia management is directed towards haemodynamic stability, facilitation of electrophysiological monitoring, and provision of optimal operative conditions and a rapid, high-quality recovery. The aim of pre-operative assessment is to identify potential anaesthetic problems and coexisting medical conditions, quantify risk and plan perioperative care. The assessment of the neurosurgical patient is identical to that of other patient groups but must additionally include a complete neurological assessment. Neuroanaesthesia is a specialty where the knowledge and skill of the anaesthetist affects both the operative field and ultimate outcome for the patient. Awake craniotomy allows the intraoperative assessment of a patient's neurological status and the identification of safe resection margins during epilepsy surgery and excision of space-occupying lesions in eloquent cortex, as well as the accurate localization of electrodes for deep brain stimulation.

Anaesthesia for the posterior fossa provides a unique challenge for anaesthetists and neurosurgeons. Optimal patient positioning should facilitate surgical access without compromising patient safety. The important considerations are surgical access, securing and maintaining the airway, maintenance of adequate anaesthetic depth, haemodynamic stability and oxygenation. Care should be taken to limit the 'blackout state' during which the patient is not monitored or connected to the breathing circuits during patient transfer or positioning on the operating table. The hazards during positioning can be reduced by meticulous planning, careful positioning and vigilance to facilitate early detection of complications. The aim of maintenance of anaesthesia is to reduce the intracranial pressure (ICP) and to maintain haemodynamic stability. Anaesthesia can be maintained with either volatile agents or intravenous agents such as propofol. The choice of the anaesthetic agent is at the discretion of the individual anaesthetist.