INTRODUCTION: Understanding geographic access to neurosurgical care is key to ensuring timely treatment, particularly in countries with challenging topography like Peru. This investigation sought to estimate Peru's population distribution within critical time intervals and proximity to the nearest neurosurgical facility in the Ministry of Health network. METHODS: A geospatial analysis was conducted to assess the distribution of Peru's population across its 25 regions within six travel time areas (1 h, 2 h, 4 h, 6 h, 1 day, and 5 days) to the nearest neurosurgical facility. RESULTS: Twenty-five facilities were identified across Peru, of which 92 % pertained to tertiary or higher-level facilities and were included in the analysis. Peru's population was estimated at 32,625,937 people. Lima concentrates 52.17 % of neurosurgical facilities. Nearly 13,819,251 people (42.36 %) could lack neurosurgical access within 4 h of travel. About 302,733 people (31.3 %) living in the region of Loreto could access neurosurgical treatment in up to 5 days of travel. CONCLUSION: Geographic access to neurosurgical care in Peru is heterogeneous. Major hospital settings remain centralized in the regions of Lima and Callao. Virtually 42.36 % of the Peruvian population could not access timely neurosurgical care within 4 h of travel. Notably, roughly one-third of the population in the Amazon area of Loreto could access a neurosurgical setting in up to 5 days of travel. These findings can incentivize further assessment of underserved regions, prioritization of infrastructure development, and synergistic policy interventions from governmental and non-governmental organizations.