Three-dimensional (3D) printing has evolved into a valuable adjunct in neurosurgery, enabling patient-specific surgical planning, simulation, education, and implant fabrication. Although its technical feasibility and clinical utility are well documented, the degree of institutional integration and further development across European neurosurgical departments remains insufficiently defined. Two cross-sectional online surveys were conducted among European neurosurgeons in 2020 and 2025. The initial survey was distributed via the European Association of Neurosurgical Societies (EANS), while the follow-up survey was disseminated through national neurosurgical societies and direct re-contact of prior participants. A total of 172 completed questionnaires from 44 countries were included. Descriptive and comparative statistical analyses were performed using chi-square or Fisher’s exact tests with false discovery rate correction. Between 2020 and 2025, significant maturation of 3D printing practices was observed. Routine or regular departmental use increased, whereas single-case-only applications declined significantly (21.8% vs. 0%, p = 0.008). Responsibility for printing shifted markedly toward in-house production: neurosurgeon-led printing increased from 0% to 27.6% (p < 0.001), while reliance on external providers decreased from 20.0% to 0% (p = 0.011). Implant fabrication emerged as a novel clinical application (0% vs. 20.7%, p < 0.001). Diversification of printing technologies and improved cost efficiency were reported; however, formal quality management procedures remained limited. Major barriers included restricted time resources, insufficient institutional support, and high costs. Over five years, 3D printing in European neurosurgery has transitioned from sporadic, externally dependent use toward structured, institutionally integrated workflows with expanding clinical applications. Standardized quality assurance, regulatory clarity, and high-quality prospective outcome studies are essential to further establish 3D printing as a routine clinical technology.