There is archaeological evidence that the first neurosurgical procedure in what is now known as Siberia was performed in 8005 ± 100 B.C. According to signs of bone growth, perhaps more than half of the individuals who received the ancient trepanations survived. In Siberia, the first operations on the human brain and spinal cord were performed in 1909 at Tomsk University Hospital by the outstanding Russian surgeon and professor Vladimir M. Mysh. Professor Mysh initially moved from Saint Petersburg to Tomsk and later to Novosibirsk. Nicolay N. Burdenko, the founder of Russian neurosurgery and the Moscow Neurosurgical Institution, began his medical education at the Tomsk Imperial University. In the 1950s, Professor Ksenia I. Kharitonova exerted her great influence upon the development of neurosurgery in Siberia. Since 1955, and for 30 years thereafter, Professor Kharitonova was recognized as a principal leader of Siberian neurosurgery. She applied every effort to spread neurosurgical knowledge, and she popularized best practices around Siberia and the Far East. Perestroika deconstructed and ultimately eliminated the orderly system of neurosurgical service in the Soviet Union. From another perspective, the process opened the window to the world. Fully equipped centers and clinics with state-of-the-art techniques for neuro-oncology, cerebrovascular diseases, neurotrauma, and spinal pathology management in Novosibirsk, Barnaul, Kemerovo, and Irkutsk were enabled.