The resolution and real-time navigation of intraoperative MRI (iMRI) has been leveraged in neurosurgery. We review frameless stereotactic biopsy platforms and focus on emerging technology integrating intraoperative MRI with frameless stereotaxy. Brain biopsy with iMRI allows for an accurate tissue sample with the ability to correct cannula trajectory during surgery, eliminating misdiagnosis secondary to faulty targeting. This technology allows for a percutaneous approach avoiding large incisions, obviates the need for frozen tissue evaluation, has the potential to reduce unnecessary specimen harvesting and operating room time, and optimizes safety of targeting deep brain lesions.