To the Editor: We read the review “Neurosurgery and Manned Spaceflight”1 with great interest. It is a well-anticipated and detailed review of the subject. The article is a gentle reminder that the neurosurgery community has to keep the pace with the future vision of the world as in this case “Space Travel.” The purpose of space travel is to overcome the earth's gravity, go out into the atmosphere, orbit the earth, travel to satellites and planets, and transport the human being back to the planet Earth. Given the limitations of telemedicine in a scenario of a journey over long distances, astronauts must have the tools to solve critical neurosurgical conditions. Panesar et al1 presented a practical review of the possible scenarios of neurosurgical pathologies that may occur in manned spaceflight. Although astronauts are a select group of trained personnel, the possibility of a neurological injury exists.2 We want to raise some aspects of brain injury and approach in microgravity conditions. Traumatic brain injury is a heterogeneous condition that can potentially affect the life of the individual. In environments of microgravity and zero gravity, humans face a high-stress state. It has been established that brain self-regulation is significantly reduced.3 The presence of venous stasis and the increase of pressures in the dural venous sinuses will lead to increased intracranial pressure. The reduction of the reabsorption of cerebrospinal fluid and the reduction of lymphatic drainage are mechanisms that aggravate cerebral edema. Thousands of kilometers away from the earth and without the possibility of neurosurgery, it is a challenge to be able to propose strategies for handling critical situations. With the advance of robotic surgery, it is possible to develop basic neurotrauma surgery (drainage of epidural or subdural hematomas). We think that research in this field should first be focused on 3 medical strategies: (a) non-pharmacological management of traumatic intracranial hematomasshould be considered, (b) non-invasive strategies for the reduction of intracranial pressure, and (c) develop space neurotrauma prevention programs. Disclosure The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.