Clinical prediction and decision rules use evidence-based medicine to assist clinicians in diagnosing and treating illness. Although widespread in modern medical practice, there are relatively few clinical rules for neurosurgical conditions. This article reviews the background of how clinical prediction and decision rules are derived, validated, evaluated, and used in practice. It also summarizes a list of clinical rules published for neurosurgical illnesses and analyzes each rule for how it was derived and whether it was validated and/or evaluated compared with similar rules. It reports on whether the implementation of each rule was studied and grades the overall quality of each report.