What is Neurosurgery? 

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Neurosurgery is a surgical speciality focused on the diagnosis, assessment, and surgical treatment of disorders of the nervous system, including the brain, spinal cord, peripheral nerves, and skull base. The speciality emerged in the early 20th century through the treatment of head and brain injuries and has since expanded with advances in technology, intensive care, and non-invasive techniques to cover oncology, neurovascular conditions, trauma, and more.

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Neurosurgery has several sub-specialities, including paediatric neurosurgery for congenital and childhood conditions, neuro-oncology for brain and spinal tumours, functional neurosurgery for epilepsy and movement disorders, neurovascular surgery for aneurysms and blood vessel abnormalities, traumatology for head and spinal injuries, skull-base surgery, and spinal surgery, which now forms a large part of neurosurgical practice.

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Neurosurgeons perform a wide range of operations such as tumor removal, spinal decompression for degenerative conditions, trauma management, treatment of infections, strokes, epilepsy, movement and psychiatric disorders, and correction of congenital malformations like spina bifida. They also manage conditions affecting cerebrospinal fluid flow, including hydrocephalus, and increasingly use advanced techniques like deep brain stimulation to treat complex neurological disorders.

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How to become a neurosurgeon

The management of neurosurgical patients requires excellent medical and surgical skills and a career in Neurosurgery offers many challenges and rewards. To train in neurosurgery in the UK the usual route is:

 

• Medical degree leading to provisional then full registration with the General Medical Council

  • Nb. Some doctors from abroad may have to take the PLAB test prior to registering with the General Medical Council

• 2 years of foundation jobs

  • These may be four or six month jobs and are designed to provide general all round medical and surgical experience.

• Application for neurosurgical training posts

  • All neurosurgical jobs in England, Scotland and Wales are appointed centrally once a year.  A separate central appointment process occurs in Ireland. Further details regarding entry requirements can be found on this website: https://www.yorksandhumberdeanery.nhs.uk/recruitment/national_recruitment/national_neurosurgery_st1__st3_recruitment/

• The MRCS examination is usually taken two to three years after full registration

• Neurosurgical trainees then progress through 8 stages of training (ST1 - ST8).  This usually takes 8 years.  The neurosurgical curriculum and more detail may be found on the ISCP website

  • The speciality board examination in neurosurgery is usually taken after completing ST6.

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After completing training and passing the examination the specialist advisory committee will consider whether a trainee is competent to complete training.   They will make a recommendation to PMETB and if a trainee is deemed competent then they will be placed on the specialist register and allowed to apply for a consultant job.

Alternatively doctors who can show that they have completed similar training schemes and achieved the same competencies may apply to be placed on the specialist register directly to PMETB using article 14.

Consultants are expected to continue developing their professional skills throughout their working lives.

 

Specialty Training

The foundation programme started in August 2005 some doctors get a limited amount of neurosurgical experience during their foundation years. There is then competitive entry into an eight year neurosurgical training programme. Selection has been centralised for Scotland, England and Wales (Ireland remains separate) and is hosted by the Yorkshire Deanery.

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This can be divided into:

Basic Neuroscience training (ST1, ST2, ST3)

The exact content of this stage depends on the training programme.  A typical training programme would include 2 years of neurosurgery and 1 year of four or six month blocks in related specialities including neurology, neurorehabilitation or neurophysiology, ENT, Plastics, neurointensive care or emergency medicine.

Intermediate Neurosurgery training (ST4, ST5)

 

Full time Neurosurgery

Final Neurosurgical training (ST6, subspecialty year, ST8)

Full time Neurosurgery
Sub-speciality year will require prospective approval, may be taken at any time during final neurosurgical training and will frequently occur in a different training programme.
Final assessment for CCT

The Intercollegiate Surgical Curriculum,  Neurosurgery Syllabus  provides a very comprehensive insight for aspiring neurosurgery.

It can be found here: https://www.iscp.ac.uk/curriculum/surgical/surgical_syllabus_list.aspx

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Life of a Neurosurgeon

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Typical day and working hours

Surgery is the main responsibility of a neurosurgeon; however, evaluating patients in clinics, emergency departments, and on ward rounds is also part of the job. Neurosurgery is a challenging specialty with long hours. Days can vary widely. For example, a typical day starts around 07:50, with gathering patient lists and preparing for ward rounds.
There is a handover meeting to discuss patients and review imaging. If a theatre list is available, pre-checks are carried out and the list of patients is discussed. There may be ward rounds, surgeries, and teaching for trainees throughout the day. The day generally ends at 18:30 or 20:30, depending on the shift. Night shifts are also common, as head or spinal trauma can occur at any time. 

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On-call commitments

Out-of-hours commitments, including weekends, are common. This includes being on call for adult and paediatric emergencies. Consultants are usually on call on a one-in-eight or one-in-nine rota. Even as a consultant, neurosurgeons have many on-call duties due to the nature of the speciality; accidents are unpredictable, and traumatic situations can be clinical emergencies.
Elective procedures can be cancelled at short notice due to emergencies. Operations can range from long and complex, such as removing a difficult brain tumour (taking 10-11 hours), to simple and straightforward, such as placing an intracranial pressure monitor (30 minutes).

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Pros and Cons of a Career in Neurosurgery

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Future of Neurosurgery

The future of neurosurgery in the UK is highly promising, shaped by ongoing advances in technology, research, and clinical practice. Innovations such as robotic-assisted surgery, advanced neuro-imaging, artificial intelligence–supported planning, and minimally invasive techniques are improving surgical precision, patient safety, and recovery outcomes. Emerging fields including neuromodulation and functional neurosurgery are also expanding treatment options and enabling more personalised patient care.

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Honorary Consultant Neurosurgeon for Glasgow Neuro​​​​​​​​​​​​​

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