Image-guided stereotactic brain biopsy has radically changed the aggressiveness of tissue acquisition procedures for analysis. Thanks to the development of different stereotactic frames, the evolution of imaging techniques (CT and MRI), and software systems, it is easier to analyze the target lesion and its access with minimal morbidity. However, the strengths and weaknesses of each imaging technique must be considered. The neurosurgeon should be familiar with the use of frame and frameless stereotactic approaches. Knowing the different artifacts that can appear in CT or MRI, the configuration of MRI sequences and the use of advanced tools to improve image quality reduce potential complications and provide confidence for the preparation of the procedure.