Paediatric neurosurgery

What is it in children?

Neurosurgeons treat conditions of the brain, spine and nerves. In children that includes hydrocephalus, brain and spinal cord tumours, spina bifida, congenital malformations, craniofacial surgery and epilepsy surgery ^[1]. Paediatric neurosurgery is one of the special interest areas named in the neurosurgery curriculum ^[2].

Typical conditions and operations

• Hydrocephalus. Treated with a shunt that drains cerebrospinal fluid, usually into the abdomen, or with an endoscopic third ventriculostomy ^[3].
• Spina bifida (myelomeningocele). The spine is closed after birth, usually within 48 hours, or in the womb before 26 weeks of pregnancy. Many babies also need a shunt ^[4].
• Medulloblastoma. The most common malignant brain tumour in children. It starts in the cerebellum, and surgery is usually the first treatment ^[5].
• Craniosynostosis. The skull sutures fuse too early, and skull reshaping surgery is done by a team that includes craniofacial surgeons and neurosurgeons ^[6].

How to get there

Neurosurgery is mostly a run-through specialty: most trainees join at ST1, straight after the Foundation Programme, and stay in neurosurgery until they finish ^[7].

1. 5 to 6 yearsMedical school

   A medical degree. To apply for the Foundation Programme you need to be eligible for provisional registration with the GMC ^[8].

2. 2 yearsFoundation Programme

   You can apply for ST1 with no more than 24 months of clinical experience after Foundation ^[9].

3. ST1 to ST2Run-through neurosurgery, phase 1

   Two years of early training. You need to pass the MRCS by the end of this phase ^[2]. In 2026 recruitment was at ST1 and ST2 only ^[10].

4. ST3 to ST7Phase 2

   Five years of training across neurosurgery. Every trainee does at least six months in a paediatric neurosurgery service. The Intercollegiate Specialty Board (FRCS) exam is taken after ST6 ^{[2, 11]}.

5. ST8Phase 3 and special interest

   A final year focused on one or two special interests, which can be paediatric neurosurgery. Fellowships in other centres are encouraged ^[2].

6. CCT, then a paediatric fellowship

   Advanced paediatric neurosurgery is learned after certification. Children's units including Great Ormond Street, Oxford, King's, Leeds, Manchester and Alder Hey offer fellowships ^{[2, 12]}.

Good to know

• Indicative length is eight years from ST1 ^[2]. Add the two Foundation years and that's about ten years after medical school.
• Exams: MRCS during phase 1, then the Intercollegiate Specialty Board (FRCS) exam in neurosurgery, which you need for your CCT ^{[2, 11]}.
• The 2027 person specifications are out, and still list ST1 and ST2 entry only ^[13].

Getting involved as a student

• SBNS affiliated membership is open to medical students for £45. You apply with a CV and a reference from an SBNS member or your course director ^[14].
• NANSIG (the Neurology and Neurosurgery Interest Group) is affiliated with the SBNS. It runs conferences and skills workshops, and an annual neurosurgery careers day jointly with the SBNS ^{[15, 16]}.