BACKGROUNDWe discuss current indications and results after stereotactic radiosurgery for the management of cerebral vascular malformations, brain tumors, and functional disorders. The development of gamma knife and modified linear accelerator technology has been associated with a significant increase in the number of gamma knife units worldwide. The clinical and experimental experience continues to be published in terms of indications for radiosurgery, medical physics testing, long-term clinical outcomes, and morbidity. Using the gamma knife, more than 50,000 patients have undergone radiosurgery worldwide. At the University of Pittsburgh, more than 2,000 patients have undergone radiosurgery during the first 9 years after installation. This review discusses indications and results from our experience.REVIEW SUMMARYAn increasing number of patients have been considered for stereotactic radiosurgery over the last 9 years. An ongoing scientific analysis of results facilitated refinements in techniques, and results continue to improve. Stereotactic radiosurgery can play an important role in the management of vascular malformations, brain tumors, and carefully selected chronic pain and movement disorders. Radiosurgery is truly a “no access” technique, but is not risk free. An appreciation of short- and long-term outcomes is necessary to obtain the best results for patients who choose this procedure as an addition or an alternative to other therapies.CONCLUSIONIn this review, we address the current status of radiosurgery for vascular malformations, acoustic neuromas, meningiomas, brain metastases, glial tumors, head and neck cancer, and trigeminal neuralgia. Indications for primary or adjuvant treatment, results and complications, and modifications of the technique are presented.