Introduction

Neurosurgery, and in particular academic neurosurgery, has, despite the tremendous progress in the last 100 years, not found its clear and solidly anchored home within the medical specialties. This stems from its dichotomic origin. Complicating the picture, these origins are different on different continents.

In the USA, neurosurgery was established as a new specialty by Harvey Cushing—a surgeon—and neurosurgery hence for a long time was a surgical subspecialty dwelling on the technical aspects of neurosurgery and, to be fair on some pathophysiology, but not really on central nervous system (CNS) biology.

In Europe, neurosurgery also branched off neurology with Otfried Foerster being an eminent neurologist, before turning to the surgical armamentarium to treat neurological disease. Ironically, Cushing and Foerster visited each other and showed admiration for their respective work.

So to simplify things and use these two paradigmatic figures as opposite ends of the spectrum, we can:

1. Outline the answer to the question posed in the title and look at the pros and cons of each description.

2. Maybe more important we can analyse the development of neurosurgery in the last decade and predict which name will be appropriate extrapolating into the future.

3. Semantics or impact: we can determine what the structural framework of neurosurgery should be to associate it with the correct description.

Neurosurgery has come a long way since the days of fairly gross CNS tissue manipulation to remove lesions, occlude vascular malformations or even ablate tissue for movement disorders and has moved to delicate microsurgical manipulation—but it is still manipulation—and neuromodulation.

The future will likely be different and adaptation be necessary if neurosurgery does not want to fall victim to ‘creative destruction’ like Schumpeter.1–3

Subspecialisation in neurosurgery is the inevitable trend to increase expertise, and analysing its development most likely allows an answer to my first point. …