Neurosurgery or/and neurological surgery, also known in common parlance as brain surgery, is the medical specialty that focuses on the surgical treatment or rehabilitation of disorders that affect any portion of the nervous system, including the brain, spinal cord, peripheral nervous system, and cerebrovascular system. Neurosurgery as a medical specialty also includes non-surgical management of some neurological conditions.
Education and context In different countries, there are different requirements for an individual to legally practice neurosurgery, and there are varying methods through which they must be educated. In most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school.
Canada In Canada, neurosurgery residency is overseen by the Royal College of Physicians and Surgeons of Canada (RCPSC). To qualify, candidates must hold a Doctor of Medicine (M.D.) degree and be licensed physicians. The residency program lasts six years, often with one year of mandatory research, as in the University of Calgary, and it comprises two years of Surgical Foundations and four years of specialized neurosurgery training. Admission is facilitated through the Canadian Resident Matching Service (CaRMS), which matches candidates to programs based on academic credentials, interviews, and references. Training requirements and certification processes differ slightly in Quebec, where the Quebec College of Physicians (CMQ) collaborates with RCPSC, but has French-language proficiency requirement and has a different application procedure. Upon completion, residents take the RCPSC examination to earn the Fellowship of the Royal College of Physicians and Surgeons of Canada (FRCSC) designation. On the other hand, to qualify for residency, International Medical Graduates must pass equivalent licensing exams, including the Medical Council of Canada Qualifying Examination Part I (MCCQE Part I) and the National Assessment Collaboration (NAC) Objective Structured Clinical Examination, to be eligible for residency. They apply through CaRMS, where competition is high, and may face additional requirements in Quebec due to French language fluency expectations.
India In India, neurosurgery training is overseen by the National Medical Commission (NMC) and the qualifying examinations by National Board of Examinations in Medical Sciences (NBEMS). To qualify, candidates must hold a Bachelor of Medicine, Bachelor of Surgery (MBBS) degree with at least 55% aggregate marks from a WHO-recognized institution, complete a one-year compulsory rotating internship, and possess a practising medical license. The pathway spans three to six years post-MBBS. A three-year residency cum degree of Master of Surgery (M.S.) in neurosurgery is the basic qualification of a neurosurgeon in India. Physicians can opt for super specialization of three years, i.e., Master of Chirurgiae (M.Ch.) after completing Master of Surgery (M.S.) in General Surgery or Neurosurgery. Qualifying exams for specialisation (M.S.) are — NEET (PG) for admission into general medical colleges and INI CET for admission into Institutes of National Importance, such as AIIMS, JIPMER, NIMHANS, and PGIMER. Super speciality selection exams are NEET SS and INI SS similarly. Neurosurgery is considered one of the most competitive specialities in India with fewer than 200 seats annually. Foreign Medical Graduates (FMG) are required to pass the FMGE for registration into postgraduate training.
United Kingdom In the United Kingdom, students must gain entry into medical school. The MBBS qualification (Bachelor of Medicine, Bachelor of Surgery) takes four to six years, depending on the student's route. The newly qualified physician must then complete foundation training lasting two years; this is a paid training program in a hospital or clinical setting covering a range of medical specialties, including surgery. Junior doctors then apply to enter the neurosurgical pathway. Unlike most other surgical specialties, it currently has its own independent training pathway, which takes around eight years (ST1-8) before being able to sit for consultant exams with sufficient amounts of experience and practice behind them. Neurosurgery remains consistently amongst the most competitive medical specialties in which to obtain entry.
United States In the United States, a neurosurgeon must generally complete four years of undergraduate education, four years of medical school, and seven years of residency (PGY-1-7). Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue additional training in the form of a fellowship after residency, or, in some cases, as a senior resident in the form of an enfolded fellowship. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, skull-base surgery, peripheral nerve and complex spinal surgery. Fellowships typically span one to two years. In the U.S., neurosurgery is a very small, highly competitive specialty, constituting only 0.5 percent of all physicians.
History
Neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years.
Ancient Neurosurgical procedures in rudimentary forms date back to antiquity. In the Roman Empire, doctors and surgeons performed neurosurgery on depressed skull fractures. Additionally, the Incas appear to have practiced a procedure known as trepanation since before European colonization. During the Middle Ages in Al-Andalus from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions, and headache. Simple forms of neurosurgery were performed on King Henry II of France in 1559, after a jousting accident with Gabriel de Lorges, Count of Montgomery, which fatally wounded him. Ambroise Paré and Andreas Vesalius, both experts in their fields at the time, attempted their own methods (although to no avail) in curing Henry. In China, Hua Tuo invented the first general anesthesia called mafeisan, which he used on surgical procedures on the brain.
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