OBJECTIVE: Despite common gender disparities in authorship across the vast majority of specialties, the presence of a similar lack of equality in neurosurgery literature is not published yet. Therefore the authors examined the changes in representation of women among the first and senior (last) authors of original articles in high-impact neurosurgical journals between 2003 and 2018. METHODS: Data regarding women proportions among the first and senior authors were collected from the issues of Neurosurgery and Journal of Neurosurgery published in 2003, 2008, 2013, and 2018. RESULTS: According to the analysis of 3247 original articles, compared with male authors, female authors have published fewer articles as the first (518 of women, 2729 of men) and senior authors (352 of women, 2884 of men). Nonetheless, the proportion of women in the first authorship represented a significant increase from 2003 to 2018 (from 12% to 16.5%, respectively; P < 0.01), but not in senior authorship (11.7% in 2003 vs. 10.5% in 2018; P > 0.05). Overall, women wrote more research articles than case reports as both first and senior authors (451 and 301 vs. 67 and 51, respectively). In addition, women demonstrated a higher percentage of first authors on female senior author articles (30.4%) than male senior author articles (14.1%). CONCLUSIONS: Although a rising trend in female authorship of neurosurgical literature has been going on through the last 2 decades, this advancement could not be regarded as satisfactory, as the gender gap in authorship is still excessive. Strikingly, female first authors had a tendency of coauthoring with female senior authors.