The Cosman-Roberts-Wells stereotactic instrument is a recently developed modification, based on an arc-radius design, of the Brown-Roberts-Wells stereotactic frame utilizing the existing fixation and fiducial components of the Brown-Roberts-Wells stereotactic system to localize and verify target data. The design modification has been made with a view to facilitating technical approaches both in stereotactic biopsy and in stereotactic craniotomy, whilst encompassing the same stereotactic space. Initial experience with the Cosman-Roberts-Wells instrument is reported. Over a 5-month period 55 procedures were performed which included 40 stereotactic biopsies, five CT-guided stereotactic craniotomies, three stereotactic placements of a Bennett Ball for thalamotomy, three stereotactic implantations of intracranial electrodes for recording in drug-resistant epilepsy, three aspirations of cyst or haematoma and one implantation of a Gutin catheter for interstitial brachytherapy. There was minimal morbidity and no mortality related to operation. This frame offers rapid targeting without the need to pre-determine entry points, as well as allowing direct lateral passes and unimpeded stereotactic craniotomy.