# What Is a Neurosurgeon and When Should You See One > What a neurosurgeon is, how the specialty differs from neurology, what they operate on and what they do not, and at which point in your medical journey it makes sense to ask for an assessment. URL: https://brainandspine-bcn.com/en/what-is-a-neurosurgeon/ Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com --- # What Is a Neurosurgeon and When Should You See One Most people reach a neurosurgeon referred by another doctor and without a clear idea of what will happen in that consultation. This is what the specialty actually does, how it differs from neurology, and at which point in your journey it makes sense to ask for an assessment. A neurosurgeon is the doctor who specialises in the diagnosis and surgical treatment of disorders of the nervous system: the brain, the spinal cord, the spine and the peripheral nerves. The specialty is reached after a medical degree and a five-year residency, almost always followed by years of subspecialisation in a particular area (tumours, spine, vascular, functional or paediatric). And, contrary to what the name suggests, a large part of the work consists of deciding who should not be operated on. ## What a neurosurgeon actually does Theatre is the visible part, but not the most frequent one. The real work is split three ways: - **Setting the indication.** Reviewing MRI, CT and neurophysiological studies, comparing them with what the patient describes, and determining whether surgery offers a benefit that medical treatment can no longer provide. A well-considered indication prevents more problems than any technical skill. - **Operating.** With the precision tools that define the specialty today: microscope, neuronavigation, intraoperative neurophysiological monitoring, endoscopy, robotics and, in functional surgery, stereotactic planning. - **Following the patient.** Surgery is a point along the journey, not the end of it. The postoperative period, rehabilitation and imaging follow-up are part of the same treatment. ## Neurologist and neurosurgeon: the difference It is the most repeated question in clinic, and the short answer is that they are not alternatives but two parts of the same circuit. ### Neurologist - Diagnoses and treats without surgery - Adjusts medication over the years - Handles routine follow-up in Parkinson's disease, epilepsy, migraine or stroke - Refers to the neurosurgeon when medical treatment stops controlling the disease ### Neurosurgeon - Assesses whether there is a surgical indication - Operates on brain, spine and peripheral nerve - Steps in when there is compression, bleeding, a tumour, or a disease no longer responding to drugs - Returns the patient to the neurologist for long-term follow-up Parkinson's disease shows this clearly: the [neurologist](https://brainandspine-bcn.com/en/neurology/) manages treatment for years and, when fluctuations appear that medication can no longer correct, the neurosurgeon steps in to assess [deep brain stimulation](https://brainandspine-bcn.com/en/brain-surgery/parkinsons-disease/dbs/). After surgery both keep following the patient: one programmes the stimulator, the other adjusts the medication. ## Which conditions they treat - **Tumours of the nervous system:** [gliomas](https://brainandspine-bcn.com/en/brain-surgery/brain-tumor-surgery/gliomas/), [meningiomas](https://brainandspine-bcn.com/en/brain-surgery/brain-tumor-surgery/meningiomas/), metastases and [acoustic neuromas](https://brainandspine-bcn.com/en/brain-surgery/brain-tumor-surgery/acoustic-neuroma/). - **Spine:** [disc herniation](https://brainandspine-bcn.com/en/herniated-disc-symptoms-treatment/), [spinal stenosis](https://brainandspine-bcn.com/en/lumbar-spinal-stenosis/), instability and deformity, both [cervical](https://brainandspine-bcn.com/en/spine-surgery/cervical-spine/) and lumbar. - **Cerebrovascular disease:** [aneurysms](https://brainandspine-bcn.com/en/brain-surgery/vascular-neurosurgery/), arteriovenous malformations and cavernomas. - **Functional surgery:** [Parkinson's disease](https://brainandspine-bcn.com/en/brain-surgery/parkinsons-disease/) and tremor, [drug-resistant epilepsy](https://brainandspine-bcn.com/en/brain-surgery/epilepsy-surgery/) and [trigeminal neuralgia](https://brainandspine-bcn.com/en/brain-surgery/trigeminal-neuralgia/). - **Peripheral nerve:** [carpal tunnel syndrome](https://brainandspine-bcn.com/en/carpal-tunnel-syndrome-barcelona/) and other nerve compressions. - **Hydrocephalus and Chiari malformation**, with shunts or endoscopic third ventriculostomy. ## When an assessment is worth asking for You do not have to wait until someone says the word surgery. There are situations where a neurosurgical assessment changes the decision: - Back or neck pain radiating down the arm or leg that does not improve after weeks of conservative treatment. - Loss of strength, clumsiness in the hands, or problems with balance and walking. - A finding on an MRI scan that nobody has fully explained to you. - A newly diagnosed brain tumour, before choosing between surgery, radiotherapy or surveillance. - A neurological condition that has stopped responding to medication. - You have been told your case is inoperable and want that checked. In any of those scenarios the least invasive step is a [neurosurgical second opinion](https://brainandspine-bcn.com/en/second-opinion-neurosurgery/): it is done with the scans you already have and without travelling. ## How to choose a neurosurgeon - **Subspecialisation.** Neurosurgery is too broad for anyone to do all of it equally well. What matters is whether they operate on your specific condition routinely, not occasionally. - **Continuity.** That the specialist who assesses your case is the one who operates and the one who follows you up. - **Honesty about the indication.** A good sign is being told just as clearly what you gain from surgery and what happens if you do not have it. ### Related information - [Our neurosurgeons and neurologists](https://brainandspine-bcn.com/en/team/) - [Remote second opinion in neurosurgery](https://brainandspine-bcn.com/en/second-opinion-neurosurgery/) - [Real patient stories](https://brainandspine-bcn.com/en/patient-stories/) - [Brain surgery](https://brainandspine-bcn.com/en/brain-surgery/) and [spine surgery](https://brainandspine-bcn.com/en/spine-surgery/) - [Travelling from abroad: second opinion, quote and logistics](https://brainandspine-bcn.com/en/international-patients/) ## Frequently asked questions What exactly is a neurosurgeon? A doctor who specialises in the diagnosis and surgical treatment of disorders of the nervous system: the brain, the spinal cord, the spine and the peripheral nerves. In Spain the specialty is reached after a medical degree and a five-year residency, almost always followed by further years of subspecialisation in one particular area. What is the difference between a neurologist and a neurosurgeon? The neurologist diagnoses and treats with medication and other non-surgical therapies; the neurosurgeon treats surgically those cases where an operation offers something medical treatment can no longer offer. They are not alternatives: in conditions such as Parkinson's disease or epilepsy, both follow the same patient for years. Does a neurosurgeon only operate? No. A large part of the work is deciding who should not be operated on. A neurosurgical consultation involves reviewing imaging, comparing how the condition has evolved and, very often, recommending conservative treatment, rehabilitation or monitoring with periodic MRI scans. Do I need a referral, or can I book directly? In private practice you can request an assessment directly, although most patients arrive referred by their GP, neurologist, orthopaedic surgeon or pain unit. What matters is bringing the actual images of your most recent MRI or CT scan, not just the written report. What does a neurosurgeon operate on? Brain and spinal tumours, disc herniations and spinal stenosis, aneurysms and vascular malformations, hydrocephalus, drug-resistant epilepsy, Parkinson's disease and tremor through neuromodulation, trigeminal neuralgia and peripheral nerve compressions such as carpal tunnel syndrome. When should I ask a neurosurgeon for a second opinion? Whenever the decision is important and only reversible in one direction: before spinal surgery, on a newly diagnosed brain tumour, when you have been told your case is inoperable, or when the diagnosis does not match what you are actually experiencing.