Fifty-one randomized trials of neurosurgical topics have been identified. These have been analyzed for content, quality of reporting, and quality of statistical design and analysis. In general, there were major omissions in the reporting of critical portions of the studies, the statistical analysis was highly variable in quality, and the statistical power was low. Few if any, major neurosurgical questions have been answered by clinical trials. This may reflect the generally low quality of these trials. To improve the quality of such trials, neurosurgeons must seek biostatistical advice in planning and conducting trials and must cooperate in multi-institutional trials to increase statistical power.