OBJECTIVE: Postoperative rehabilitation is crucial for neurosurgical patients' rehabilitation, but access in low- and middle-income countries (LMICs) is often limited. Telerehabilitation offers a cost-effective, accessible alternative by providing remote therapy through digital platforms. This study compared telerehabilitation with traditional methods in LMICs, focusing on cost-effectiveness, clinical outcomes, and patient satisfaction. METHODS: A systematic review was conducted using PRISMA guidelines, with searches across PubMed, Embase, IEEE Xplore, and Web of Science. Studies were included if they focused on telerehabilitation for neurosurgical patients in LMICs and assessed cost-effectiveness or cost savings, along with clinical outcomes. Data extraction and quality assessments were performed using Covidence, with risk of bias evaluations conducted with the ROBINS-I tool. RESULTS: The authors' review included 20 studies with 40,537 neurosurgical patients, demonstrating telemedicine's role in patient care, from initial consultations to postoperative follow-ups. Cost analysis revealed specific savings such as 1.80 per patient in India for neurosurgical follow-ups, 88 to 501 per visit in the US for patients from underserved areas, and .8 million in stroke and injury care in France. Patient satisfaction showed an average rate of 97% (95% CI 94%-98%, p = 0.06). Additionally, the combined analysis estimated an 88% probability of achieving a favorable outcome (95% CI 68%-96%, p <
0.01). Intervention efficiency revealed a rate of 97% (95% CI 96%-99%, p <
0.0002). CONCLUSIONS: Telerehabilitation in neurosurgical care for LMICs offers a transformative solution, dramatically reducing healthcare costs, improving access, and maintaining the quality of care. With proven effectiveness across large patient populations, telemedicine bridges critical gaps in neurosurgical treatment, highlighting an urgent global need to scale its implementation. This technology could revolutionize healthcare in resource-limited settings, mitigating the geographic, financial, and infrastructural barriers that have long hindered equitable neurosurgical care worldwide.