The challenge for treating complex lesions with the aim of minimal surgery-related morbidity has generated an increasing demand for sophisticated intraoperative imaging modalities. Newest generations of intraoperative computed tomography (CT) scanners offer a multitude of hardware and software improvements resulting in higher image quality that further propagates its everyday usage in the interdisciplinary operative setting. This article describes workflow and applicability of intraoperative CT scanning in cranial neurosurgery, in subspecialties like skull base or vascular neurosurgery, and its advantages and limitations.