Modern society is characterized by having an ever increasing geriatric population. More and more of these patients are presenting with various neurological problems that may need surgical intervention so as to improve the quality of life. The elderly patient for neurosurgical operations definitely poses a challenge for the neuroanaesthesiologist as compared to their younger counterparts. Care of the elderly patient requires involvement of a multidisciplinary team comprising the neurosurgeon, neuroanaesthesiologist, cardiologist, physician and intensivist. Several factors are critical for a good outcome in these patients: (1) A careful preoperative evaluation and optimization of comorbidities, (2) formulating a surgical and anaesthetic plan keeping in mind the nature of the underlying neurological disease and the physical status of the patient, (3) meticulous attention to maintain intraoperative cardiovascular stability, respiratory function, intravascular volume status and electrolyte balance, and (4) postoperative pain management and intensive care monitoring in a neurocritical care unit.