The university hospital of North Norway hosts the northernmost neurosurgical department in the world. The hospital is located in the city of Tromsø, often dubbed "the Gateway to the Arctic." We describe the role of this city in polar exploration, the history preceding the establishment of the world's northernmost university, the history of neurosurgery at this institution, and the present state of the Department of Neurosurgery. The experience from Tromsø shows that it is possible to establish a complete neurosurgical service at remote locations. Training of physicians native to the region, close integration between clinical activities and research, and a wide definition of the specialty has been essential for the success of the department.