Background: accurate localization of a lesion is the ultimate goal of stereotactic surgery. Frame-based systems have the advantage of proven clinical utility and instrument carriage with a high degree of mechanical stability and accuracy. Aim of the work: this study aimed to investigate the incidence of miss targeting in frame based stereotactic brain surgery. Patient and methods: this was a retrospective study and included non-comparative, consecutive case series of 200 cases of different intracranial lesions, using CT imaged Leksell G stereotactic brain surgery, for diagnostic 180 cases or therapeutic 20 cases purposes and they performed at Sayed Galal University Hospital and other neurosurgical centers at Egypt between Jan 2015 and Jan 2018. Results: there were 120 males and 80 females. The procedures were performed under local anesthesia. Diagnostic purposes were the most encountered procedures for 180 cases, while therapeutic were 20 cases. The incidence of miss targeting was 2% of the studied group, which was noticed among the diagnostic group (2/180 = 0.011%) more than the therapeutic group (2/20=10%). Conclusion: the incidence of miss targeting in frame based stereotactic brain surgery is a concern and must be suspected. Recommendations: stereotactic surgical team must evaluate every surgery steps very carefully.