Neurosurgery as an independent discipline at Groote Schuur Hospital in Cape Town commenced with the return of Hermann de Villiers Hammann from Munich in 1946. He developed the unit with Alex Gonski, J.P. Van Niekerk, P. Keet, and A.P. Rose-Innes. Jacquez (Kay) C. de Villiers followed in 1966, becoming the first Helen and Morris Mauerberger Professor and chairman of neurosurgery at Groote Schuur Hospital, the Red Cross War Memorial Children’s Hospital, and Conradie Hospital. During that period, many contemporary South African neurosurgeons received their training, and the unit developed and expanded its reputation as a center of excellence in Africa. Since 1994, Jonathan C. Peter has been the Helen and Morris Mauerberger Professor and chairman of the department, which now consists of six full-time neurosurgeons, six part-time consultants, seven registrars, and two interns. Two to three thousand outpatients are treated each year, and approximately 1000 surgical procedures are performed. Sociopolitical changes in South Africa have resulted in a reduction in funding of tertiary academic health services, and this presents major challenges for the future.