Abstract Cho Ray Hospital is the premier tertiary care center in Ho Chi Minh City, Vietnam’s most populous city. The neurosurgical department was founded in 1958 and is currently one of the busiest in the world. Last year the department was responsible for over 10,000 neurosurgical operations, excluding neuroendovascular cases. Most of the elective cases are craniotomies for complex lesions such as aneurysms, AMV’s, skull base tumors, gliomas and meningiomas. While the neurosurgeons within the department are technically gifted, doing more with less predominates as the mantra at Cho Ray Hospital. The necessity to minimize costs and the scarcity of resources creates many unique circumstances, some of which lag decades behind the rest of the world. Nonetheless, the progress and trajectory of the department has been impressive as the neurosurgical care provided to the Vietnamese public continues to improve. This article describes the current state and future direction of The Department of Neurological Surgery at Cho Ray Hospital.