Background: Studies in the literature suggest preoperative laboratory investigations and cross-match are performed unnecessarily and rarely lead to changes in clinical management. This study explored whether preoperative laboratory investigations in neurosurgical children alter clinical management and to determine the utilization of cross-matched blood perioperatively in elective pediatric neurosurgical cases. Methods: We reviewed patient charts for elective neurosurgery procedures (2010-2014) at our institution. Variables collected include preoperative complete blood count (CBC), electrolytes, coagulation, group and screen, and cross-match. Instances of altered clinical management as a consequence of preoperative investigation were noted. The number of cross-matched blood transfused perioperatively was also determined. Results: 477 electively scheduled pediatric neurosurgical patients were reviewed. Preoperative CBC was done on 294 and 39.8% had at least one laboratory abnormality. Electrolytes and coagulation panels were abnormal in 23.8% and 24.5% respectively. The preoperative investigations led to a change in clinical management in three patients, two of which were associated with significant past medical history. 57.9% had blood cross-matched and 3.6% of patients received perioperative blood transfusions. The cross-match to transfusion ratio was 16. Conclusion: This study suggests that the results of preoperative laboratory exams have limited value, apart from cases with oncology and complex pre-existing conditions. Additionally, cross-matching might be excessively conducted in elective pediatric neurosurgical cases.