As a neurologist, one of the first things people say to me is “So, do you do brain surgery?!” The answer is “no”. No neurologist performs brain surgery. But it is a very common misconception. Because the names sound so similar, and both specialists care for the brain, spine, and nervous system, it is clear why there is confusion. The truth of it is, even though we share patients and overlap in the conditions we treat, the training we undergo, the way we approach care, and the tools we use are all very different.

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Neurology:  Medical management

Neurologists, like myself, are medical doctors who diagnose and treat conditions of the brain, spinal cord, nerves, and muscles without the need for surgery. We focus on conditions such as migraines, epilepsy, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, stroke, neuropathy, and many others. Our training consists of four years of medical school, followed by a one-year internship in internal medicine and then a three-year neurology residency. Some of us, including myself, go on to obtain additional subspecialty fellowship training. Our training gives us the tools to effectively use medications, lifestyle strategies, rehabilitation, and some minimally invasive procedures, such as the administration of Botox or trigger point injections, to help manage these conditions.

We are trained to recognize subtle patterns in symptoms, interpret imaging and EEG studies, and provide guidance for long-term care of chronic neurological conditions.

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Neurosurgery: Surgical management

Neurosurgeons are surgical specialists. They also take care of the brain, spine, and nerves — but their role is very different. They also attend medical school, but then move into a 7-year surgical residency program, starting with general surgery in the early years and then specializing in neurosurgery in the final four years.

Neurosurgeons can also pursue fellowship training following their residency, including fellowships in pediatric, oncology, and spine specialties. Their training equips them with the ability to perform operations for conditions such as brain tumors, aneurysms, spinal cord compression, Chiari malformations, or herniated discs. If something is structurally pressing, bleeding, or needs to be physically repaired or removed, a neurosurgeon is the right specialist to consult. While they certainly understand neurological diseases, their training is focused on acute, hands-on correction of problems, rather than long-term medical management.

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Meeting of the minds

There are numerous situations where neurologists and neurosurgeons work together. For example, a patient with a new onset seizure may come into the Emergency Department. Neurology consult will first be called to help medically manage the patient. We will stop the seizure with IV medications and then draw labs and maybe order imaging to uncover the cause. Should we discover a hemorrhage or mass in the brain that likely was the source of the seizure, neurosurgery will be called next to operate to remove the inciting factor.

This collaboration also extends to outpatient conditions, such as back pain. These patients will often first be referred to neurology to utilize medications, lifestyle modifications, and physical therapy to help alleviate the symptoms. However, if a diagnostic workup reveals a compressed nerve, we will refer the patient to neurosurgery for a potential discectomy.

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Two puzzle pieces

It is essential that neurologists and neurosurgeons maintain a healthy working relationship, as we rely on each other to provide our patients with optimal care. Both roles are unique and essential, as we trained separately for years to master two very different skill sets. The roles of a neurologist and a neurosurgeon are by no means interchangeable but rather complementary. This strong partnership ensures the best clinical outcomes for many patients with complex neurological conditions..

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