Bioactives derived from marine sources are opening up new therapeutic opportunities for neurosurgery. These include tissue regeneration, neuroprotection, and infection control. These molecules derived from extreme marine conditions have generated new modes of action, for example, selective inhibition of voltage-gated ion channels and influencing pathways of neuroinflammation. Representative examples include chitosan for nerve regeneration, conotoxins for pain modulation, and fucoidan for neuroprotection. Despite therapeutic promise, major challenges remain: those of sustainable sourcing and regulatory validation. This letter points up the potential of marine bioactives to change neurosurgical care and challenges the brain communities to work together across disciplines in order to make that happen.