The neurosurgical patient is exposed to high blood loss due to the lesions to be operated on and the duration of the surgeries. Reducing anemia and perioperative bleeding avoids complications, improves outcomes, and reduces costs. To achieve this objective, in addition to the strategies of increasing the hemoglobin level with iron and erythropoietin, and blood saving with PABD, acute normovolemic and hypervolemic hemodilution, cell salvage (cell saver), there are additional therapies and strategies that can be performed by the anesthesiologist and surgeon during the perioperative process. Conditions that may increase the risk of intraoperative and postoperative bleeding such as comorbidities, medications, and herbal medicine are detected and corrected preoperatively; the anesthetic management with the correct position of the patient, temperature adequacy, acid-base and electrolyte status, choice of anesthetic technique, hemodynamic and ventilation management; strategies with antifibrinolytics and hemostatics such as tranexamic acid, desmopressin, factor concentrates and sealants; and the rationalization of blood sampling and patient-side coagulation analysis methods, points of care (POCs), such as viscoelastic methods (VHAs) with rapid information for timely decision making make perioperative bleeding less. On the other hand, the surgical preparation of the patient, the number of surgeons, experience, and the decisions, devices, and techniques to be used are also determining factors that together with the others described try to achieve the goal of minimizing perioperative bleeding and thus better outcomes.