Neurosurgery is a dynamic field encompassing a wide range of procedures involving the cranium and spinal cord, alongside rapidly advancing subspecialist areas such as awake craniotomy, interventional neuroradiology, functional neurosurgery, and intraoperative magnetic resonance imaging (iMRI). To support these complex procedures and deliver high-quality perioperative care, the neuroanaesthetist must have a comprehensive understanding of neurophysiology and the pathophysiology of underlying neurological conditions. This review article provides an update to a previously published paper.