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Although significant achievements have been made in the perioperative care of patients undergoing cardiac surgery, adverse cerebral outcomes remain an ongoing concern. Multiple approaches have been utilized to address neurologic complications, though definitive therapeutic strategies are lacking. This review focuses on the various cerebral monitoring options that can be used in cardiac surgery to improve perioperative outcomes.Prevention of adverse outcomes has shown promise, and central to this is the identification of conditions, through cerebral monitoring, which may put the brain at risk. Multimodal cerebral monitoring utilizing hemodynamics, temperature, electroencephalography, and near-infrared spectroscopy techniques allow for the manipulation of perioperative conditions aimed at improving cerebral outcome.The use of a comprehensive cerebral monitoring strategy can optimize cerebral outcomes after cardiac surgery.