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To the Editor: The laryngeal mask airway (LMA) has the advantage of attenuating the pressure response during its insertion compared with tracheal intubation and the associated increase in heart rate is very short lived. ~,2 The LMA also results in minimal coughing and produces a smooth emergence from anaesthesia. In the neurosurgical patient small perturbations in blood pressure may initiate total or regional cerebral ischaemia and may even enhance cerebral oedema formation by further elevating ICP. 3,4 Thus, cerebral blood flow increase due to blood pressure elevations may lead to a progressively decreasing cerebral perfusion pressure. We, therefore, used the LMA in place of intubation in five neurosurgical patients between the ages of 7-52 yr, who were to undergo elective ventriculo-peritonial (VP) shunt. Following preoxygenation anaesthesia was induced. The LMA was then connected to the Acoma Anaespirator KMA 1300 F 11 for controlled ventilation. The procedures were uneventful. We observed that the LMA produced acceptable haemodynamic stability during its insertion, and emergence from anaesthesia was smooth. We feel that the role of LMA in the management of airway in neurosurgical patients should be extended. We suggest that the LMA should be considered an alternative to tracheal intubation in elective, short neursurgical procedures such as VP shunts.