In neuropsychology, case conceptualization traditionally has been centered on psychopathology, but the interaction between the individual patient, the health care providers, and the family system is often neglected. Building a connection between the patient, family dynamics, neuropsychological assessment findings, and recommendations for neurosurgical intervention presents new challenges for neuropsychologists working with patients and families within a neurosurgery context. The role of the neuropsychologist in the setting of a neurosurgery practice demands that an understanding of family systems dynamics be utilized when assessing, conceptualizing, and engaging in treatment planning. Various neurological disorders requiring surgical intervention involve specific considerations that will impact not only the individual, but also the family system. Variables such as premorbid psychopathology, caregiver issues, expectations, legal considerations, loss of identity, and much more, are explored in the chapter. Eligibility criteria and contraindications for surgical intervention may collide with family members’ expectations or needs and subsequently impact surgical decision-making. One of the complex tasks facing the neuropsychologist is to serve as a type of “broker” between the patient, the family, and the neurosurgery team.