Neurosurgery and the neurologist.

When Thomas Willis (1621–1675) first used the term “ neurology” in Cerebri Anatome to mean knowledge of the cranial, spinal, and autonomic nerves, he did not specify whether practitioners should be physicians or surgeons. The physicians won the mantle but somehow this did not catch the imagination of the public or even aspiring doctors in the same way as that of being a “brain surgeon”, a term proverbially ranked alongside “rocket scientist”, indicating the very acme of medical achievement. With more modesty the Society of British Neurological Surgeons (SBNS) defines the specialty of neurosurgery as that of “the clinical management of patients with potentially surgical remediable conditions of the central (intracranial and spinal) and peripheral nervous system”. In their important document Safe neurosurgery 2000, they recommend that neurosurgical units should be situated within a multidisciplinary neuroscience centre on a general hospital site, and should provide both core and subspecialty services. While neurosurgery is thus commonly sited alongside neurology, the reverse is not always true. An increasing number of UK neurologists, while regularly attending a neuroscience centre, spend the majority of the working week away from their surgical colleagues. Neurologists thus need to be informed and equipped to work without immediate access to a neurosurgeon. The links between our specialties have changed beyond all recognition over recent years. While Victor Horsely and William McEwan were regarded as the founders of British neurosurgery, it was Harvey Cushing, not much troubled by a lack of neurologists, that trained and influenced the first generation of UK specialist surgeons (Cairns, Jefferson, Dott, Sloan Robertson, and McConnell). The second world war saw the spawning of the regional neurosurgical units and the birth, outside London, of the neurological physician. In the 1960s and ’70s our specialties worked in close collaboration up until the advent of cross sectional imaging. The increased availability and non-invasive nature of new scanning technology weakened the links between neurologists and neurosurgeons as the neurologist ceased to be the “gate keeper” for neurosurgical referral. Developments in interventional neuroradiology and tumour management are now changing the face of neurosurgery. Subspecialty interests in epilepsy, movement disorders, and cerebrovascular medicine have resulted in closer working partnerships between some neurologists and their neurosurgical colleagues, while in other areas our disciplines have diverged.