What Is a Neurosurgeon?

Medically Reviewed by Jabeen Begum, MD on February 21, 2024
Written by Tammy Worth
6 min read

 

Neurosurgeons are medical doctors who diagnose and treat conditions related to the brain, spine, and other parts of your nervous system. Because neurosurgeons are experts in the human nervous system, they perform a wide variety of duties in addition to surgery. For instance, other health specialists such as emergency room doctors and neurologists often consult with neurosurgeons regarding their cases. Neurosurgeons also help evaluate and rehabilitate people with neurological conditions.

Neurosurgeon vs. neurologist

Neurosurgeons differ from neurologists because they're specifically trained and certified in the use of surgical treatments. But that doesn't mean they would always recommend you have surgery. A neurosurgeon will evaluate you and may suggest nonsurgical treatments such as physical therapy to manage back pain.

A neurologist doesn't perform surgery. You would see a neurologist if you have a condition that affects your nervous system. The neurologist would perform tests, evaluate you, and offer nonsurgical treatment. If they feel like you would benefit from surgery, your doctor will suggest you seek treatment from a neurosurgeon.

There’s a myth that neurosurgeons spend all of their time in surgery. In reality, they have many other responsibilities. It can be hard to predict exactly what an appointment with a neurosurgeon will involve.

As some of the most experienced and highly trained specialists in medicine, neurosurgeons spend a great deal of time consulting with other doctors about various cases. They also have their own roster of cases, each with unique challenges. Not all of these cases will need surgery, though many likely will.

Neurosurgeons treat people with a range of neurological issues, such as:

  • Lower back pain or chronic back and neck pain.
  • Peripheral nervous system disorders, where nerves that carry messages to and from the brain don't work properly.
  • Brain tumors.
  • Carpal tunnel syndrome, a common hand condition where the nerve in the carpal tunnel of the wrist is compressed.
  • Spina bifida, a condition present at birth where the neural tube in the spine and the backbone don't form correctly, causing damage to the nerves and spinal cord.
  • Essential tremor, a condition of the nervous system that causes uncontrollable shaking, often in the hands.
  • Multiple sclerosis, a chronic condition where damaged nerves in different parts of the body lose their ability to receive messages from the brain.
  • Trauma to the head, brain, and spine.
  • Spinal conditions such as bone spurs, fractures, and tumors.
  • Meningitis, a serious infection of the outer part of your brain or spinal cord, has symptoms similar to those of a fever, but they last longer and are more severe. The condition can be either viral or bacterial.
  • Spinal disk herniation, where the inner material of a spinal disk swells and pushes through the outer membrane.Spinal disks are cushions between your vertebrae that prevent the bones of your back from rubbing against each other. Serious discomfort can result if spinal disks flatten or rupture.
  • Parkinson’s disease, whichaffects the part of your brain that controls movement. It can cause tremors, balance issues, and other problems. Parkinson’s disease is usually treated with medication, but if it severely affects quality of life, a neurosurgeon can implant an electrode that stimulates your brain and provides relief from symptoms.
  • Epilepsy, a central nervous system disorder where lesions on the brain cause seizures.

Your primary care doctor may refer you to see a neurosurgeon if they think you have a condition that could use a more comprehensive exam and testing.

What to expect

During your first visit, it's a good idea to come prepared with:

  • Test results from other doctors
  • A list of your health concerns, major changes you've experienced, and symptoms
  • A list of medications you take
  • A list of any known allergies
  • A friend or relative who can take notes and help remember follow-up visits or other information

Your neurosurgeon will do an exam that may include asking questions to understand your mood, alertness, and cognitive ability. The doctor may also test your cranial nerves to find out if your senses of touch, taste, vision, and hearing are working well. A motor function test will measure the strength in your upper and lower body. A sensory function test will tell your doctor if you can feel when something is touching your skin when your eyes are closed. Finally, your doctor will test your reflexes.

If your doctor recommends surgery, be prepared to talk with them about what will be involved and what you can expect. Good questions to ask include:

  • When you will need to have the surgery
  • How much experience your doctor has with that surgery
  • What potential risks and benefits the procedure has
  • Whether you should get a second opinion
  • Where and how you will recover from surgery
  • How to prepare for the surgery

Once the neurosurgeon has performed an examination and other tests and knows the source of the problem, they can find a method to treat it effectively.

Neurosurgeons use state-of-the-art imaging technologies to diagnose different brain, neck, and spinal conditions. Some of these tests include:

  • Magnetoencephalography (MEG scan) is a noninvasive scan that measures magnetic fields in the brain to find the source of seizures.
  • Magnetic resonance imaging (MRI) uses magnetic and radio waves to create detailed pictures of the inside of the body.
  • Positron emission tomography (PET scan) uses a radioactive drug, which is injected into a vein and collects in areas of the body where cancer may be located.
  • Computed tomography (CT scan) uses X-rays rotated around your body that give a 3D image with more detail than a standard X-ray.
  • Nerve conduction velocity and electromyography tests are used to stimulate nerves and muscles and measure how quickly your body responds to find damage.
  • Angiograms help find aneurysms and other blood vessel issues in the brain. The procedure involves the injection of a dye into blood vessels, followed by an X-ray.

Neurosurgeons provide many kinds of care including consulting with other doctors, medication management, disease prevention, and rehabilitation. They also perform a wide range of neurosurgery procedures on different parts of the nervous system and the structures that support it. These procedures and surgeries include:

Brain surgery

  • Repairing aneurysms and trauma to the brain
  • Removing blood clots and tumors
  • Inserting shunts into the brain to remove fluid buildup and pressure
  • Stopping excess bleeding (hemorrhages)

Spinal surgery 

  • Stereotactic spine radiosurgery uses radiation to treat cancerous and noncancerous tumors on the spine.
  • Diskectomies remove part of a herniated disk that can't be improved using conservative treatment.
  • Laminectomy removes part of the bony arch of the spine to take pressure off your nerves and spinal cord.
  • Spinal fusion attaches two or more vertebrae together to increase your back's stability and relieve pain
  • Reconstruction and stabilization of the spine
  • Surgical treatment of compression fractures in the spine

Peripheral nerve surgery

  • Vagus nerve stimulation: An implantable device is used to send electric impulses to your brain to treat epilepsy, depression, and strokes.
  • Ulnar nerve release: In this procedure, the surgeon fixes an ulnar nerve (which runs from your armpit to your hand) that is compressed or dislocated.
  • Carpal tunnel release: In this, the doctor cuts the ligament that is pressing the carpal tunnel and causing pain.

Neurosurgeons have one of the longest training periods of any doctor. Their training consists of:

  • 4 years of medical school
  • A 1-year surgical internship
  • 5-7 years of residency
  • Often an additional year studying a subspecialty such as pediatric neurosurgery, epilepsy surgery, spinal surgery, or neuro-oncology

Additionally, future neurosurgeons must receive certification from the American Board of Neurological Surgery (ABNS) before they’re allowed to practice. Board certification requires an extensive period of both written and oral examination.

Neurosurgeons, unlike neurologists, are doctors who specialize in surgery of the brain, spinal cord, and nerves. Neurosurgeons go through 14-16 years of training and sometimes receive subspecialties such as functional neurosurgery. If your doctor recommends you see a neurosurgeon, it doesn't mean you will have surgery. These doctors also help manage and treat pain with nonsurgical care.

  • What salary do neurosurgeons make? Neurosurgeons are the highest-paid specialty physicians, averaging more than $750,000 a year.
  • How serious is neurosurgery? This depends on what kind of surgery you have. Some conditions a neurosurgeon treats, such as sciatica and other chronic pain, can be treated without surgery. Brain and spinal surgeries tend to come with more risk and potential complications. Your doctor can talk to you about what to expect after surgery.