Frailty is a multidimensional syndrome characterized by decreased reserves, which is prevalent in elderly surgical population and associated with poor postoperative prognosis. Preoperative frailty assessment is an effective method to guide clinical de⁃ cision⁃making and reduce the perioperative risk. But frailty has not attracted sufficient attention in neurosurgery. This article summariz⁃ es the common methods for clinical frailty assessment and reviews the progress on frailty in cranial neurosurgery, so as to optimize the perioperative management of elderly neurosurgery patients. At present, there is still considerable heterogeneity in the studies concern⁃ ing neurosurgical frailty. In the future, more studies are required to further explore the frailty assessment methods and effective periop⁃ erative interventions suitable for neurosurgery patients.