Eighty patients older than 65 years underwent craniotomy for primary or secondary brain tumors. Glioblastoma was the most common tumor, followed by metastatic carcinoma and meningioma. Three patients died within 30 days of surgery. Twenty-three patients showed development of postoperative systemic complications, of which pulmonary complications were most common. Thirty-seven (44%) of the patients showed significant improvement, but 13 (21%) became worse after surgery. Most brain tumors in elderly patients are operable. However, the surgical indications should be determined by the nature of the tumor and the condition of the individual patient. Preoperative and postoperative management must be more demanding if systemic complication are to be avoided.