A total of 33 patients presenting with various cerebral lesions were operated on with stereotactic guided craniotomy. In all cases the lesion could be totally removed and only one patient suffered from a recurrent metastasis. The survival time of patients with malignant brain tumors was in the range of the generally reported data. All the six patients with malignant gliomas developed a recurrence, four of them have since died. Three of the four patients with brain metastases died from systemic progression of their disease, and one patient died from a recurrence of a centrally located metastasis. A new neurological deficit occurred in only two patients. Despite the often deep or central localization of the lesions, major complications were rare. Stereotactic guidance and preoperative selection of the entry point allow a safer surgical procedure, a larger indication for open surgery in cases considered as not removable, and reduce surgical morbidity.