Surgery is progressing rapidly into a less invasive mode, shorter hospital stays, less pain, lower morbidity and mortality. Perhaps, no surgical specialty has benefitted more from this advancing technology then neurosurgery. Refinements in magnification, illumination and instrumentation have propelled neurosurgery into a new era. The advent of the operating microscope led to numerous instrumentation innovations. Various types of lasers were adapted to the microscope. The ultrasonic aspirator was added. Stereotactic neurosurgery is moving into the ultrasonic guidance and frameless stereotactic systems. Percutaneous and endoscopic neurosurgery are more recent advances.