Intraoperative cell salvage (ICS) is widely used in many surgical specialties, but uptake in neurosurgery has been slow. Little direct evidence exists to support the use of ICS in neurosurgical procedures; however, studies suggest that ICS may be safe and cost-effective in intracranial surgery and spinal fusion. Nationwide ICS is used in less than 50% of neurosurgical centers often without clear local guidance. It is most commonly used in major spinal surgery and least often surgery for intracranial glioma or metastatic deposits. The major barriers to more widespread introduction of ICS appear to be concern about tumor dissemination in cases of malignancy, lack of trained staff to use the machinery and perceived lack of necessity. Some evidence suggests that when ICS is used in tumor resection surgery, meningioma (benign) cells are less likely to be detectable in salvaged blood than glioblastoma (malignant) cells but, in contrast to other surgical subspecialties, the use of leukocyte depletion filters to remove tumor cells has not been investigated and the impact of ICS usage on tumor recurrence and long-term survival rates is unknown. The unpredictable nature of blood loss in neurosurgery means that many units do not use ICS routinely even though hemorrhage is often rapid and substantial when it does occur. No nationally recognized guidelines currently exist to support the use of ICS specifically in neurosurgical procedures although the majority of UK neuroanesthetists feel that a standards document would be beneficial.