Emergency Neurosurgery is a constantly evolving specialty, resulting in ever increasing challenges posed on the higher specialty trainee. The focus of this Element is to guide the reader on the application of robust and easily applicable management strategies whilst dealing with the most challenging aspects of their professional workload. The authors have categorised the various subgroups of emergency neurosurgical workload, devised a comprehensive management algorithm, included case scenaria related to the most challenging emergency situations and highlighted easily overlooked clinical information. In summary, this Element will provide robust and easily applicable management strategies whilst dealing with the most challenging aspects of the emergency neurosurgical workload.