We discuss the current status of stereotactic radiosurgery in the management of cerebral vascular malformations and tumors. The development of gamma unit and modified linear accelerator technology has been associated with the incorporation of these techniques into neurosurgical institutions across the world. Management philosophies and clinical experience reports continue to be published in terms of the indications for radiosurgery, the physical parameters of irradiation, management successes, and any observed morbidity. Using the gamma unit, >9,000 patients worldwide have now had radiosurgery. At the University of Pittsburgh, > 1,000 patients were treated over the last 51/2 years, and this article discusses those results that have lead to an evolution of radiosurgical technique.