OBJECTIVE: The ongoing war in Ukraine has introduced many challenges to an already overburdened and resource-limited medical system. Longitudinal collaborations, material support, educational outreach, and surgical mentorship are essential for improving outcomes and standards of neurosurgical care in extreme settings such as in times of war. METHODS: Operating in Ukraine since 2016 through the coordination of Razom, the Co-Pilot Project has organized multiple United States-based mission trips to Ukraine to support local physicians during wartime, including a trip between April and May of 2023. RESULTS: A team of two anesthesiologists, two neurosurgeons, a neurointerventional radiologist, and an industry representative providing technical expertise aided in the instruction and performance of complex neurosurgical and neurovascular procedures by Ukrainian physicians at St. Panteleimon Hospital and St. Nicholas Children's Hospital in Lviv. Such efforts are crucial for helping to address the sharp rise in elective neurosurgical volume caused by the increase in internally displaced persons in Western Ukraine since February 2022. In an illustrative case, the authors provide an in-depth description of a foramen magnum meningioma resection via a far lateral craniotomy in a 48-year-old female. CONCLUSIONS: Despite the supply shortages and logistical challenges brought on by war, the Co-Pilot Project continues to utilize a long-term approach to continually improve the operative capabilities of Ukrainian neurosurgeons through both in-person and virtual collaborations. It is hoped that the lessons learned from a recent trip to Ukraine will help to inform and inspire other global neurosurgery initiatives in the future.