Over the past 50 years, more advancement has been made in cerebrovascular surgery (CVS) than in any other field of medicine. The author was to describe development of CVS in Korea by reviewing this country's history of neurosurgery, and his own personal experience as a vascular neurosurgeon. The first CVS was performed in 1948 on a patient with an intracerebral hematoma. Open carotid angiography was first performed in 1956, but was soon replaced with a percutaneous procedure. In the 1960s, several passionate neurosurgeons made attempts to treat ruptured cerebral aneurysms by carotid ligation in the neck or by a direct approach, however the outcomes were less than optimal. Aneurysm clips with springs were not available until late in that decade. In the 1970s, great strides were made in aneurysm surgery, thanks to the revolutionary introduction of the surgical microscope and refined microsurgical techniques. Microvascular anastomosis also became possible for cerebral blood flow augmentation. In the late 1970s, CT scan and 4-vessel angiography were introduced to improve the diagnosis of cerebrovascular disease. Also at this time, there was great interest among vascular neurosurgeons in the treatment of arteriovenous malformations (AVMs) and intracerebral hemorrhage. Korean vascular neurosurgeons began presenting their papers at international meetings. At that time, most of the basic researches were focused on cerebral vasospasm and ischemia. By the 1980s, major health care centers in the country had the resources to perform both aneurysm and AVMs surgery. Surgery of the posterior circulation aneurysms became commonplace. In addition, radiosurgery became available for the treatment of AVMs. In 1986, vascular neurosurgeons organized a study group on cerebrovascular disease, which eventually developed into the Korean Society of CVS. A partnership was formed with Japanese neurosurgeons to create a biannual Korean-Japanese Friendship Conference on Surgery for Cerebral Stroke. In the 1990s, a new era in CVS was opened with advanced neuro-imaging technology, skull base surgery, endovascular surgery, neuro-navigation, and reappraisal of carotid surgery. The International Workshop on CVS was proudly hosted in Seoul in the year 2000. The present advanced state of CVS in Korea was made possible only by the selfless efforts of devoted neurosurgeons, neurologists, and neuroradiologists who had limited resources to work with. Long recognized as possibly the most technically challenging medical field requiring the most precision, CVS has come of age in the struggle to improve the outcome of patients with cerebrovascular disease.