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Female Pioneers in Neurosurgery in the Caribbean. The field of neurosurgery in the Caribbean has long been shaped by systemic limitations in infrastructure, training opportunities, and gender representation. Despite these challenges, a small group of pioneering women have broken through traditional barriers to become leaders in Caribbean neurosurgery. This narrative review highlights the contributions and career trajectories of female neurosurgeons across the region, offering historical and contemporary perspectives on their clinical, academic, and leadership roles. Through a combination of literature review and direct outreach, we document the stories of the first female neurosurgeons in Curaçao, Trinidad and Tobago, Jamaica, Guyana, Saint Lucia, the Dominican Republic, Cuba, and Puerto Rico. Their achievements span advanced surgical innovations, including the introduction of percutaneous transforaminal endoscopic discectomy in the Caribbean, establishment of local neurosurgical departments, and leadership in academic and global neurosurgery initiatives. The article also examines persistent disparities in neurosurgical training and representation, particularly among women and underrepresented minorities. These stories underscore the critical importance of resilience, mentorship, and advocacy in driving progress in a traditionally male-dominated field. By documenting these contributions, we aim to amplify the visibility of Caribbean female neurosurgeons and inspire further efforts to promote equity and diversity in neurosurgery, both regionally and globally.