Abstract: Objective To carry out a meta-analysis to evaluate the efficacy and safety of Remifentanil-Propofol versus Fentanyl-Propofol during total intravenous anesthesia for neurosurgery. Methods Databases including the Cochrane library（Issue 3,2013）, the database of the Cochrane anesthesia group, MEDLINE, PubMed, EMBASE, Ovid, Springer, CNKI, VIP database and Wanfang data were electronically searched from inception to October 2013 for the randomized controlled trials （RCT） of Remifentanil-Propofol versus Fentanyl-Propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results 8 trials involving 474 patients were included. The results of meta-analysis showed that: ① Hemodynamic changes: Compared with Fentanyl-Propofol group, the MAP changes during intubation period （WMD= -4.58, 95%CI -6.84 to -2.32, P<0.000 1） were more stable in Remifentanil-Propofol group, but with no significant differences in the induction, headpins insertion, incision and extubation period. There were no significant differences between the two groups for HR in the 5 periods. ② Drug dosage: There were no significant differences in the Propofol dosage （WMD=-0.71, 95%CI -2.08 to 0.66, P=0.31） between the two groups. ③ Emergence time and Extubation time: Compared with Fentanyl-Propofol group, emergence time （WMD=-6.83, 95%CI -7.83 to -5.84, P<0.000 01） and extubation time （WMD=-12.26, 95%CI -17.04 to -7.48, P<0.000 01） were significantly shorter in Remifentanil-Propofol group.④ Side effects: There were no significant differences in side effects （such as nausea and vomiting, cough, bradycardia and hypotension between the two groups. Conclusion Remifentanil provides patients with the quicker and better postoperative awakening quality, but there were no differences in the incidence of side effects or the Propofol dosage.