Recognizing the need for detailed training and special qualifications for the practice of neurosurgery, representatives from The Society of Neurological Surgeons and the Harvey Cushing Society [now the American Association of Neurological Surgeons (AANS)] held an informal gathering on March 27, 1939 to discuss the concept of a Board. Those in attendance were Drs. Alfred W. Adson, Paul C. Bucy, Winchell McK. Craig, Loyal Davis, Howard C. Naffziger, Eric Oldberg, Max M. Peet, and R. Glen Spurling. This group was later enlarged to include representatives from the Section on Nervous and Mental Diseases and the Section on Surgery of the American Medical Association (AMA), the American Neurological Association, and the American College of Surgeons (ACS). On November 19, 1939 the first preliminary meeting was held at the Palmer House in Chicago, Illinois. In addition to the above, Drs. Leo M. Davidoff, Temple Fay, Tracy J. Putnam, and Ernest Sachs were included. Dr. Howard C. Naffziger was elected Chairman, Dr. Alfred W. Adson Vice-Chairman, and Dr. R. Glen Spurling Secretary/Treasurer. A second preliminary meeting of the same group, with the addition of Dr. Byron Stookey, was held on April 28, 1940 at the Park Plaza in St. Louis, Missouri. The group unanimously decided that a separate Board should be formed for certification in neurological surgery, and guidelines were established to grandfather neurosurgeons who could be certified without examination.

The American Board of Neurological Surgery was approved as a new examining Board in medical specialties in 1940 by action of the Advisory Board for Medical Specialties [reorganized in 1970 as the American Board of Medical Specialties (ABMS)] in collaboration with the AMA Council on Medical Education. On August 15, 1940 the ABNS was incorporated. N. B. Burdete, N. C. Evans, and W. W. Downing served as signatories. Directors of the corporation were designated as those individuals in attendance at the second preliminary meeting.

The first official meeting of the ABNS was held in Chicago on October 17, 1940. Twenty-four candidates for certification were examined. The 100th official meeting was held September 23 to 26, 1986, in Salt Lake City, Utah. The 50th anniversary meeting was held in Boston, Massachusetts, May 15 to 18, 1990, at which time the 3672nd Diplomate was certified.