Intraoperative rapid diagnosis has been a useful neurosurgery tool for maximal resection and minimal morbidity. However, only a few studies have been conducted regarding diagnostic accuracy and associated problems. The present study reviews our experience in treating patients and investigates the accuracy and problems associated with intraoperative rapid diagnosis in surgical neuropathology. There were 180 cases of intracranial lesions excluding pituitary lesions. The patients consisted of 89 males and 91 females, ranging from 5 months to 84 years, with a mean age of 46 years. Of the 180 cases, 152 cases received open surgery, 28 cases had stereotactic surgery including a biopsy and were histologically verified. The correlation between the intraoperative diagnosis and the final diagnosis overall was seen in 172 of 180 cases, proving a high diagnostic sensitivity of 95.6%. No correlation was seen in 8 cases (4.4%). The diagnostic inaccuracy was seen in the grading of gliomas and the diagnosis of undifferentiated malignant tumors such as undifferentiated metastatic carcinomas, primitive neuroectodermal tumors (PNETs), and sarcomas. It was also recognized in rare types of histology such as gliomatosis and xanthomatous lesions. These results suggested that the intraoperative rapid diagnosis was quite useful, but that we should also maintain a cautious attitude.