Diathermy is used widely in neurosurgical procedures, mainly for subcutaneous and deeper layers dissection. The use on scalp and skin of other body parts has been precluded by the fear of scar formation and wound dehiscence. One-hundred-and-seventy-seven skin incisions for neurosurgical procedures have been performed using the micro-needle electrocautery scalpel (MES) and the steel scalpel. The elements in this study included: electrocautery generator unit, cutting mode, power, waveform, size and shape of the MES, depth of the incision, the speed of the electrode movement through tissue, amount of blood loss, physical inspection of the wound edges and wound complication. Patients tolerated the procedures well, with no increased risk from the use of the MES. Only two incisions had wound infection and dehiscence. All other patients had usual wound healing. Time taken during skin opening was significantly shorter when using the MES. Blood loss during skin opening was three to five times less when the micro-needle electrocautery scalpel was used. The MES is both safe and useful in neurosurgical procedures. The findings of this study recommend the use of the MES in all neurosurgical procedures, especially when blood loss has significant importance, such as in paediatric cases.