BackgroundClimate change is a significant challenge that the medical community must address. Hospitals are large facilities with high water and energy consumption, as well as high levels of waste generation, which makes it important to pursue green hospital initiatives. Neurosurgery requires substantial energy for surgeries and tests. MethodsBased on the keywords “Climate change,” “green hospital,” “neurosurgery,” “energy consumption,” “environmental impact” listed in this paper, we extracted representative manuscripts, and the practices employed in the authors’ hospital were assessed. ResultsThe “Guidelines for Environmental Consideration in Hospitals” and “Guidelines for the Sustainability of Hospital Environments” have been developed; however, they are not implemented in most hospitals in Japan. Inhalational anaesthetics were found to contribute significantly to greenhouse gas emissions. Educating patients and staff and employing the “8 Rs” (rethink, refuse, reduce, reuse, recycle, research, renovation and revolution) showed promise in achieving green hospital standards. ConclusionThe advent of ‘green hospitals' in Japan is imminent. The active participation of neurosurgeons can play a crucial role in diminishing the environmental footprint of health care while simultaneously enhancing medical standards. Given the pressing challenges posed by climate change, there is a critical need for an overhaul of medical practices. It is imperative for neurosurgeons to pioneer the adoption of new, sustainable medical methodologies.