Background and Aim: Vascular neurosurgical expertise is highly in demand in African countries.To create a sustainable environment for treating the patients, local neurosurgeons have tobe trained and be able to operate under the local circumstances, and equipment and on-sitefellowship programs are needed. We have reported the results of the first completed on-sitecerebrovascular fellowship in Cameroon and to our knowledge, in central Africa. Methods and Materials/Patients: Forty-two cerebrovascular cases (38 aneurysms) wereoperated by the cerebrovascular expert and his fellows microsurgically from April 2021to November 2022. The expert traveled to Cameroon four times. Online conferences andtheoretical courses were organized.Results: The overall morbidity rate was 10.5% with a long-term functional morbidity rate of5.2%. The intraoperative mortality rate was 0 and the 30-day mortality rate was 2.7%. Aftercompletion of the program, the fellow’s surgical skills concerning operating time, intraoperativecomplications, and mortality improved significantly. Conclusion: The on-site cerebrovascular fellowship program in sub-Saharan countries is feasibleand provides the patient with high-quality surgery with outcomes similar to Western countries.The caseload in two years is sufficient enough to provide excellent training to the local fellows.There is a high demand for further fellowships, like the one we described. It is important for thetrainer to stay dedicated to the program until the completion of it. To provide the fellows with ahigh caseload, only two fellows should be trained, which are participating in every case