Many neurosurgical patients are at high risk of developing thromboembolic disease. Although recent data support the benefit of pharmacological thromboembolic prophylaxis, the optimal starting point for the different neurosurgical procedures remains unclear because the potentially devastating consequences of intracranial or intraspinal haemorrhage could easily offset the reduction in thromboembolic morbidity and mortality resulting from pharmacological thromboembolic prophylaxis. The objective of our study was to assess the use of pharmacological methods of thromboembolic prophylaxis in contemporary German neurosurgery using a postal survey in 34 neurosurgical departments. Low-dose heparin or low molecular weight heparin (LMWH) were used in 88% to 97% of neurosurgical units participating in our survey. In craniotomies, in 2 units (6%) heparin or LMWH was routinely started before surgery, in 10 units (29%) < 8 hours after surgery, in 15 units (44%) < 24 hours after surgery, in one unit at the second day and in 5 units at the third day after surgery. Data for burr hole craniotomy or spinal surgery were similar. In our survey a high rate of perioperative use of pharmacological thromboembolic prophylaxis was found. However, given the data from the literature, the optimum protocol remains unclear.