INTRODUCTION Ukraine, formerly part of the USSR, gained its independence in 1991, and has continued to rely on medical contributions in various ways including physician capacity building. The field of neurosurgery in the country has been improving rapidly, in part, due to the establishment of collaborative partnerships with centers of excellence throughout the world. METHODS Since August 2016, we have coordinated 15 separate trips to Ukraine with several of our American neurosurgical, neurologic, and orthopedic colleagues; we have consulted on hundreds of patients and performed scores of surgeries with our Ukrainian partners at multiple sites throughout the country. We regularly provide guidance via email communication on complex cases, send surgical instruments and equipment, conduct online epilepsy conferences, and provide training opportunities to our Ukrainian partners. RESULTS Since 2016, co-pilot physicians from the United States assisted Ukrainian partner physicians on 79 major brain and spine operations during trips to Ukraine. While we mostly operated on patients with benign brain tumors, a wide variety of cases were performed including clip ligation of aneurysm, microvascular decompression, functional hemispherotomy, temporal lobectomy, implantation of vagal nerve stimulator, spinal cord detethering, Chiari decompression, shunting, and correction of complex spinal deformities. Endovascular (e.g., coil embolization of cerebral aneurysm) and intraventricular endoscopic procedures were also performed with partners who had these capabilities. CONCLUSION The Co-Pilot Project has been successful in developing long-term relationships with Ukrainian physicians and enhancing the field of neurosurgery in the country. We believe that many of the lessons learned from our project in Ukraine can serve as a template for collaborative efforts in other countries who seek further advancement through strategic partnerships.