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This article describes data from 11 patients evaluated before and after neurosurgical intervention for treatment of brain tumor, subdural hematoma and hydrocephalus. The Neurobehavioral Cognitive Status Examination NCSE was administered pre and postoperatively. Improvement was documented by the NCSE in 6 of the 11 patients. In the remaining five patients, there was evidence of deterioration in cognitive functioning. After clinical and diagnostic reevaluation by the physician, four patients had repeat operations. Followup evaluation after the second operation was useful in determining treatable and nontreatable causes of progressive cognitive deterioration. In these patients use of the NCSE may have expedited effective diagnostic evaluation and subsequently improved patient care. Such instruments have clinical utility since they are easily administered, pragmatic, and objectify subtle changes in cognitive functioning which may be early signs of increased intracranial pressure or complications of surgery.