Background and objective: This study was designed to evaluate early postoperative cognitive recovery after total intravenous anaesthesia with remifentanil–propofol or sufentanil–propofol in patients undergoing craniotomy for supratentorial expanding lesions. Methods: Sixty patients were consecutively enrolled, and randomly assigned to one of two study groups: remifentanil–propofol or sufentanil–propofol anaesthesia. To evaluate cognitive function the Short Orientation Memory Concentration Test (SOMCT) and Rancho Los Amigos Scale (RLAS) were administered to all patients in a double-blind procedure before surgery at 15, 45 min and 3 h after extubation. Results: Mean extubation time was similar in the two groups (13 ± 5 min vs. 19 ± 6 min). A significantly larger number of patients in the remifentanil–propofol group than in the sufentanil–propofol group required antihypertensive medication postoperatively to maintain mean arterial pressure within 20% of baseline (18/30 vs. 4/29; P = 0.0004). Intergroup analysis showed no differences in baseline SOMCT scores (28 ± 1 vs. 28 ± 1) whereas mean SOMCT scores at 15, 45 min and 3 h after extubation were significantly higher in the remifentanil–propofol group (30 patients) than in the sufentanil–propofol group (29 patients) (22 ± 3 vs. 16 ± 3; P < 0.0001 and 27 ± 1 vs. 22 ± 3; P < 0.0001; 28 ± 1 vs. 26 ± 2; P = 0.0126). Conclusions: In conclusion, propofol–remifentanil and propofol–sufentanil are both suitable for fast-track neuroanaesthesia and provide similar intraoperative haemodynamics, awakening and extubation times. Despite a higher risk of treatable postoperative hypertension propofol–remifentanil allows earlier cognitive recovery.