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Image-guided procedures, such as computed tomography (CT)-guided stereotactic and ultrasound guided methods, can assist neurosurgeons in localizing the relevant pathology. The characteristics of image-guided procedures are important for their appropriate use, especially in brain biopsy . This study reviewed the results of various image-guided brain biopsies to ascertain the advantages and disad vantages. Brain biopsies assisted by CT-guided stereotactic, ultrasound-guided , Neuronavigator-guid ed, and the combination of ultrasound and Neuronavigator-guided procedures were carried out in seven, eight, one, and three patients, respectively. Four patients underwent open biopsy without a guiding system. Twenty of 23 patients had a satisfactory diagnosis after the initial biopsy. Three patients failed to have a definitive diagnosis after the initial procedure, one due to insufficient volume sampling after CT-guided procedure, and two due to localization failure by ultrasound because the le sions were nonechogenic. All patients who underwent biopsy using the combination of ultrasound and Neuronavigator-guided methods had a satisfactory result. The CT-guided procedure provided an ef ficient method of approaching any intracranial target and was appropriate for the diagnosis of hypodense lesions, but tissue sampling was sometimes not sufficient to achieve a satisfactory diagno sis. The ultrasound-guided procedure was suitable for the investigation of hyperdense lesions, but was difficult to localize nonechogenic lesions. The combination of ultrasound and Neuronavigator methods improved the diagnostic accuracy even in nonechogenic lesions such as malignant lymphoma. There fore, it is essential to choose the most appropriate guiding method for brain biopsy according to the radiological nature of the lesions.