Hemostasis in neurosurgery has evolved significantly over the past few decades. New advances in hemostatic agents, some developed specifically with neurosurgical applications in mind, allowed for more effective control of difficult intraoperative bleeding. These agents vary in the mechanism of action and each may be indicated in different and often highly specific situations. Here we present a review of the most commonly used hemostatic agents, their mechanism of action and their indications. Focus is placed on key aspects and considerations regarding the use biosurgical materials in neurosurgery, with emphasis on clinical appropriateness and patient safety.