Telemedicine is defined as an application of digital communication tools in order to improve diagnostic and therapeutic options for patients without unneccessary visits. Prior to the COVID-19 pandemic, the implementation of telehealth in neurosurgery was gradual. However, with the start of the pandemic, there was a significant increase in the need for these digital tools in routine neurosurgical practice. In our study, we first compared the utilizitation of telemedicine in the year prior to the COVID-19 pandemic (between 11 March 2019 and 9 March 2020) with the year when the pandemic was officially declared in Croatia (between 11 March 2020 and 10 March 2021). Afterwards, we assessed the trend of telemedicine application in the following years of the post-pandemic period in our department. Overall, there were 336 telemedicine consults in the pre-pandemic year and 504 in the pandemic year. The number of neurosurgical trauma-related consults during the pandemic was significantly higher compared to the pre-pandemic period (288 and 138, respectively, p < 0.0001). Neurosurgical trauma patients requiring consults in the pandemic year were significantly older when compared with neurotrauma patients before the pandemic (64.9 ± 18.5 and 60.6 ± 19.1, respectively, p = 0.03). On the other hand, the number of admissions to our department and emergency procedures did not significantly differ between these two periods. Furthermore, in order to evaluate the trend of post-pandemic telemedicine usage we collected the total number of consults in the following periods: between 11 March 2021 and 10 March 2022, between 11 March 2022 and 10 March 2023, and finally between 11 March 2023 and 10 March 2024. For these time-periods there were 405, 490 and 462 consults, respectively. Overall, these results suggest an increased reliance on telemedicine in neurosurgery in our department following the COVID-19 pandemic, regardless of emergency cases. Taken together, our results suggest that the COVID-19 pandemic had a notable effect on the usage of telemedicine in neurosurgical practice. These unique healthcare circumstances forced the accelerated implementation of digital communication in neurosurgery which still persists in the post-pandemic period.