Background: Central venous pressure (CVP) measurement is a reliable method for evaluating intravascular volume status and cardiac function, but it is an invasive method that results in some well known complications. To compare CVP with peripheral venous pressure (PVP) transduced from a peripheral intra venous catheter and to assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during neurosurgical procedures. Methods: Twenty five adult patients with ASA 1and 2 undergoing craniotomy procedures lasting more than three hours were studied in this prospective clinical trial. A subclavian central vein catheter and a 18-G peripheral intravenous catheter over forearm dedicated to measuring PVP were placed in all patients after standard general endotracheal anaesthesia induction and institution of mechanical ventilation. Peripheral venous pressure and CVP were recorded every 5 minutes and/or during predetermined, well-defined surgical events. Simultaneous invasive mean arterial pressure, urine output were also monitored. Results: Peripheral venous pressure correlated highly with CVP in every patient, and the overall correlation among all patients calculated using a random-effects regression model was r = 0.893 ( P b 0.0001). A Bland-Altman analysis used to determine the accuracy of PVP in comparison to CVP yielded a bias of -4.12 mmHg and a precision of 1.99 mmHg. Conclusion: Our study confirms that PVP correlates with CVP even under adverse hemodynamic conditions in patients undergoing major neurosurgical procedures.