Despite the substantial growth of telemedicine and the evidence of its advantages, utilization of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the COVID-19 pandemic has limited typical evaluation of patients with neurological issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients’ perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuro exam. However, we argue that an accurate and comprehensive neurologic exam can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. Additionally, certain neurosurgical visits such as post-operative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.