Craniofacial surgery is currently firmly established as a subspecialty, and operations previously regarded as exceptional are considered routine. A range of complications still can occur, however, from minor to devastating in nature. As transcranial surgery is more frequently performed, craniofacial units must take steps to prevent such problems, recognize them early, and treat them expeditiously. Infection and uncontrollable bleeding are the two most feared complications. Craniofacial teams should maintain accurate audit data on morbidity and mortality and clinical outcomes to monitor complication rates. This article reviews the literature on craniofacial complications and makes recommendations for their avoidance and treatment based on the 23-year experience with transcranial pediatric surgery at the Royal Children's Hospital, Melbourne, Australia.