The potential of positron emission tomography (PET) to investigate accurately in vivo pathophysiology has opened new perspectives for the management of neurological disorders, especially brain tumors. Integration of PET in the management of brain tumors represents a unique way to provide metabolic and functional information that can be used for diagnosis, guidance of therapies, and treatment monitoring. We have developed a stereotactic method allowing the routine integration of PET images in neurosurgical procedures with a high precision. Our ten year experience with the use of PET in stereotactic conditions for neurosurgical guidance, indicates that PET integration in image-guide neurosurgical approaches, including [1] stereotactic biopsy, [2] neuronavigation and [3] radiosurgery with Leksell Gamma Knife, is feasible and worthwhile, in that it provides complementary information that contribute to the optimization of the neurosurgical treatment of brain tumors.