Neurosurgery during pregnancy is rare and as a result there are few evidence-based recommendations in the literature to provide guidance. An understanding of maternal physiology and a multidisciplinary approach are imperative to ensure a successful outcome. This chapter presents a case study of a 37-year-old female with multiple hematologic co-morbidities presented at 18 weeks gestation with perioral and periocular twitching, memory lapses and a recent sensory loss and painful paresthesias affecting the right side of her body. After a multidisciplinary discussion involving neurosurgery, obstetrics, and hematology it was decided to proceed with intracranial aneurysm clipping via craniotomy at 18 weeks gestation. A smooth intravenous rapid sequence induction with cricoid pressure was performed using lidocaine, fentanyl, propofol, and succinylcholine. Neurosurgery in a pregnant patient is rare and requires a thorough understanding of the physiologic changes of pregnancy and the associated concomitant anesthetic risks to both mother and fetus.