Intraoperative magnetic resonance imaging (MRI) allows neurosurgeons to perform surgery interactively using magnetic resonance (MR) guidance. Low-field and high-field strength MRI has been developed and implemented for multiple neurosurgical procedures, including brain biopsies, craniotomies for resection of mass lesions, cyst drainages, laminectomies, thermal ablations, functional neurosurgery, and a variety of miscellaneous cases. Both technologies have the advantage over frameless neuronavigational systems of being able to perform near real-time imaging, which allows the surgeon to compensate for intraoperative brain shift. Intraoperative functional techniques such as MR spectroscopy, functional MRI, MR angiography and venography, and diffusion-weighted imaging, which have become routine at some high-field MR units, can significantly influence surgical decision making. The potential complications associated with intraoperative MR-guided neurosurgery are similar in incidence to those seen in the conventional neurosurgical operating room. However, the immediate recognition of such intraoperative complications with MRI should lead to improved outcomes and decreased medical costs. Untoward events associated with performing surgery in an MR environment are uncommon. Intraoperative MR-guided neurosurgery represents a natural progression from framed and frameless stereotactic techniques. Intraoperative MRI is still in its infancy, and the full capabilities of this technology have yet to be determined or implemented.