• Completion of a seven-year (84 month) ACGME-approved residency
• Passing the ABNS written Primary Examination for credit prior to the chief year of residency
• Registration with the ABNS prior to completion of residency
• Submission of 10 consecutive major operative cases as the attending neurosurgeon within approximately 6 months of graduation and starting practice approved by ABNS POST® reviewer
• Submission of 125 major operative cases as the attending neurosurgeon within three years post-training approved by ABNS POST® reviewer
• Application submission with references, licensure, and hospital privileges in good standing, $2000 fee
• Current on all Continuing Certification requirements (annual dues are not required for candidates) see Continuing Certification for these requirements
• Oral Examination fee: $4000

• Three 45-minute rotations: general neurosurgery, a chosen focus area, and five selected cases from the candidate-submitted case log.
  • Focus areas: Spine, Tumor (Neuro-oncology), Vascular, Functional, Neurocritical Care/Trauma, Pediatric Neurosurgery, General.
   
  • Each rotation involves five clinical scenarios and two examiners. There are three pairs of examiners for each candidate, with a different pair for each rotation.
    • Examiners focus on each candidate’s breadth of knowledge and patient safety with an emphasis on clinical judgment, management plans, and rationale for decisions.
     
    • A silent observer may participate in the rotation to monitor and ensure exam quality standards.
    • During each case, a simulated clinical scenario is presented. These clinical scenarios may take place in various settings like the emergency room, neurosurgical office, or intensive care unit. An overall presentation of the history and examination is provided. Candidates actively participate in the process and are free to ask for data they feel is needed to solve the problems presented. Relevant test results and images are discussed and presented. The candidate is expected to formulate a differential diagnosis based on the history, physical examination, and relevant tests. The candidate is then asked to provide an initial management plan, which may include a surgical procedure and thus would require the candidate to present the details of the surgical procedure. They must also manage perioperative or intraoperative complications and discuss postoperative management and complications.
    • See Recognition of Focused Practice (link) for information about exam requirements for Recognition of Focused Practice.

    Examiners focus on the candidate's clinical judgment and are open to alternative, justifiable solutions that are reasonable treatment options. Candidates also must be able to describe the natural history of a disease in detail. The exam comprehensively covers the entire spectrum of neurosurgical diseases, reflecting scenarios encountered in routine consultations or emergency room coverage regardless of candidate practice focus. Candidates are evaluated against the expected performance of junior neurosurgical staff, with particular attention to patient safety during management.

Topics may include but are not limited to: 

• Trauma craniotomy 
• Intracerebral hemorrhage (from any cause) 
• Acute stroke care; hemicraniectomy, suboccipital decompression 
• Vascular dissection 
• Atherosclerotic vascular disease 
• Central nervous system infections
• Intratumoral hemorrhage, pituitary apoplexy 
• Cauda equina syndrome 
• Spinal cord injury management
• Spinal fracture management 
• Brain tumors/neoplasms (see below) 
• Hydrocephalus 
• Neurology (MS, temporal arteritis, and others that mimics a surgical presentation) 
• Baclofen pump failure, drug withdrawal/overdose 
• Peripheral nerve disorders 

Spine

• Degenerative spine 
• Spinal tumors 
• Spinal vascular malformations 
• Spinal pain
• Deformity 
• Instrumentation
• Infections

Tumor (Neuro-oncology) 

• Glioma management 
• Brain metastases
• Meningioma
• Vestibular or other schwannoma 
• Brain mapping
• Pineal region tumor
• Intraventricular tumors
• Spinal tumors 
• CNS lymphoma 
• Pituitary/sellar tumors 
• Endoscopic surgery 
• Skull base tumors 
• Pediatric tumors

Vascular 

• SAH/aneurysm care (clipping, endovascular)
• AVM
• AVF
• Cavernous malformation
• Ischemic disease/stroke
• Endarterectomy
• Bypass
• Moya-Moya disease

Functional

• Movement disorders
• Epilepsy
• Pain, trigeminal neuralgia
• Behavioral disorders
• Neurology (Parkinson’s disease, Essential tremor) 

Trauma/Critical Care

• Brain, spine, peripheral nerve injury surgery
• Injury physiology
• Critical care management
• Intracranial pressure management
• Secondary injury 
• Infection
• Systemic injuries

Pediatric Neurosurgery

• Full spectrum of cranial and spinal pediatric neurosurgery 

• The oral exam pass point is determined after psychometric analysis adjusting for the severity of examiners and questions, and the answers to questions. An answer to a question deemed unsafe may result in failure.
• Results are communicated approximately 2-3 weeks post-examination.
• Candidates will receive their ABNS certificate and be considered a Diplomate of the American Board of Neurological Surgery after passing the oral exam
• Diplomates must participate in Continuing Certification and annual dues payment
• Candidates who fail can retake the exam twice. If the candidate fails three times, the candidate will need to retake the written examination and start the oral examination application process again: Link .

The ABNS Directors regularly review and update the examination process to ensure it assesses candidates' knowledge and ability to provide safe, rational patient care effectively.

• Candidates for the oral examination who completed their residency after June 30, 2017, must submit a completed application, including practice data and references, by December 31st of the third year, following completion of residency. For example, those who finished on June 30, 2020, must apply by December 31, 2023.
• Extensions
  • The ABNS executive director may grant extensions at no cost for “good cause,” such as military service, post-residency training, family or medical leave, solo practice in underserved areas, or other valid reasons making practice data submission impractical within the three- or four-year deadline. Further extensions require ABNS board approval.
  • Candidates requesting extensions for “good cause” may need to provide supporting documentation, including third-party attestations, if requested by the executive director.
  • Candidates seeking extensions without good cause may be granted extensions of up to six months following the original submission deadline with a potential penalty of $1,000 per month. 
  • Extension requests, with or without good cause, must be received by the ABNS at least 60 days before the original deadline to be considered. Late requests require a $5,000 reinstatement fee and will not be considered if received more than three months after the original deadline.
  • “Without cause” extensions will not exceed six months beyond the original deadline. After six months, candidates must restart the board certification process and cannot claim board eligibility. This does not apply to rare “good cause” exceptions extending beyond six months.