The Lancet Commission on Global Surgery has recently focused its attention on the lack of surgical care worldwide. Like other surgical subspecialties, neurosurgical care needs to be better distributed around the world, with a major focus on low- to middle-income countries. Neurosurgical diseases like hydrocephalus, traumatic brain injury, and brain tumors have a high impact on families, individual quality of life, and cost for the society. Implementation of neurosurgical care in poor settings is not easy. More than other surgeries, neurosurgery requires great amounts of human resources, dedicated environments, and specialized postoperative care. It is responsibility of the neurosurgical community to identify major areas of current gaps and outline strategies for intervention. •Global neurosurgery is a critical necessity among global surgery.•Global neurosurgery has been off the government priority list for years.•Neurosurgical resources do not cover all the LMICs needs.•Many initiatives have been proposed to improve neurosurgical care in LMICs.•World neurosurgery need to find solutions to provide adequate neurosurgical services.