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About Intercollegiate Specialty Examination in Neurosurgery — Section 1

Intercollegiate Specialty Examination in Neurosurgery — Section 1 · GB

Key exam facts

Provider
JCIE governs the Intercollegiate Specialty Examination on behalf of the four surgical Royal Colleges, served by the Neurosurgery Specialty Board; Pearson VUE delivers Section 1 CBT.
Format
Section 1 consists of two computer-based Single Best Answer papers taken on the same day at Pearson VUE test centres in the UK and Ireland. Section 2 clinical/oral assessment is separate and excluded.
Exam questions
Total questions: 240.
Time limit
2 hours 15 minutes per paper; 4 hours 30 minutes of answering time in total. This does not include check-in, tutorials or breaks.
Passing score
Angoff standard setting at day-one consultant level; one standard error of measurement (SEM) is added to the cut score to set the pass mark, after review/removal of problematic items. No universal fixed percentage is specified by this procedure.
Exam fee
GBP: through 31 December 2026, Section 1 £580 (combined Section 1 and 2 entry £2,000); from 1 January 2027, Section 1 £600 (combined entry £2,070). The full combined amount is payable at initial online application and credited to the candidate fee account; resit fees are deducted from that account, with top-up required when insufficient.

Topics covered

  • EMRYOLOGY AND MALDEVELOPMENT

    • Embryogenesis of the brain and spinal cord
    • Embryogenesis of supporting structures - skull and vertebral column
    • Common anatomical variations and developmental abnormalities

  • ANATOMY OF THE SKULL

    • Structure, blood supply, innervation, surface and three-dimensional relationships of the: scalp, skull, meninges, orbit, cranial fossae, cranial foraminae, cranial nerves

  • ANATOMY OF THE BRAIN

    • Cortical topography
    • Projection and association tracts
    • Organisation of the basal ganglia
    • Structure, organisation and connections of the cerebellum, pons and brainstem
    • Cranial nerves and their relationships
    • Visual and auditory pathways
    • Ventricular system and choroid plexus
    • Subarachnoid space and cisterns
    • Circle of Willis and principle regional and segmental blood supply
    • Venous drainage and dural sinuses

  • ANATOMY OF THE SPINE

    • Structure, blood supply, innervation, surface and three-dimensional relationships of the: vertebral column, spinal cord: ascending and descending tracts, spinal nerve roots, cauda equina

  • ANATOMY OF THE AUTONOMIC AND PERIPHERAL NERVOUS SYSTEM

    • 4 Sympathetic and parasympathetic pathways
    • 4 Visceral and pelvic innervation: control of sphincter function
    • 4 Brachial plexus
    • 4 Lumbosacral plexus
    • 4 Course, distribution and innervation of the major peripheral nerves

  • FUNCTIONAL NEUROPHYSIOLOGY

    • Structure and function of neurones and glial cells
    • Synaptic function, action potentials and axonal conduction
    • Higher cerebral functions
    • Sleep and coma
    • Memory and disorders of the limbic system
    • Control of motor function: ascending and descending pathways, basal ganglia and cerebellar function
    • The special senses
    • Functions of the autonomic nervous system
    • Hypothalamic-pituitary function

  • PRINCIPLES OF CLINICAL NEUROPHYSIOLOGY

    • Principles of electroencephalography
    • Principles of somatosensory, motor and brainstem evoked potential monitoring
    • Peripheral neuropathies and entrapment neuropathies including: structure and function of peripheral nerves, use of nerve conduction studies
    • Disorders of the neuromuscular junction including: structure and function of smooth and striated muscle, use of electromyographic studies

  • PATHOPHYSIOLOGY OF INTRACRANIAL DISORDERS

    • Cerebral blood flow and metabolism
    • Cerebral autoregulation and vasospasm
    • Blood brain barrier and cerebral odema
    • Intracranial pressure dynamics
    • Cerebral ischaemia and neuroprotection
    • CSF hydrodynamics - production and absorption

  • PRINCIPLES OF NEUROPHARMACOLOGY

    • Receptor and ion channel function
    • 4 Neuropeptides and neurotransmitters
    • 4 Principles of pharmacological neuroprotection
    • 4 The pharmacology of anaesthetic agents, muscle relaxants, barbiturates, anticonvulsants and corticosteroids including: mechanisms of action, pharmacodynamics, interactions

  • PRINCIPLES OF NEUROPATHOLOGY

    • Acute and chronic inflammatory processes in the CNS including demyelination
    • Bacterial, fungal and parasitic meningitis, encephalitis and abscess formation
    • Viral encephalitis
    • Slow viruses, CJD and vCJD
    • HIV associated infections, tumours and leucoencehalopathies
    • Cytopathology of neurones and glial in response to ischaemia, hypoxia and trauma
    • Diffuse axonal injury
    • Macroscopic brain and spinal cord injury including effects of brain shift, herniation and raised ICP
    • Classification, epidemiology and pathology of CNS tumours
    • Tumour biology, cell kinetics, tumour markers, immunocytochemistry

  • PRINCIPLES OF NEURORADIOLOGY

    • Interpretation of plain radiographs of the skull and spine
    • Principles of computerised tomography of the brain, skull and spine
    • Interpretation of CT scans with particular reference to acute spinal disorders, cranial trauma, hydrocephalus, intracranial tumours and spontaneous intracranial haemorrhage
    • Principles of basic magnetic resonance imaging
    • Interpretation of MRI scans with particular reference to acute spinal disorders, cranial trauma, hydrocephalus and intracranial tumours
    • Principles of advance magnetic resonance imaging including fMRI, DWI and spectroscopy
    • Interpretation of angiographic images: CTA, MRA and DSA

  • PRINCPLES OF NEUROPSYCHOLOGY

    • The principles of neuropsychological assessment
    • Common neuropsychological problems associated with head injury, subarachnoid haemorrhage, hydrocephalus, structural lesions of the frontal and temporal lobes and disorders of the limbic system

  • PRINCIPLES OF NEUROLOGICAL REHABILITATION

    • The principles of neurological rehabilitation including strategies to optimise the recovery of cognition, communication, continence, selective movement, gait, self-care, psychological stability, social adjustment and employment

  • MEDICAL ETHICS

    • Criteria for the diagnosis of brainstem death
    • Diagnosis and management of persistent vegetative states
    • Prognosis in chronic progressive neurological disorders
    • Professional and statutory framework governing living directives and end-of-life decisions

  • PRONCIPLES OF NEUROGENETICS

    • Inherited neurological disorders
    • Genetic control of neural connectivity
    • Inborn errors of metabolism
    • Molecular genetics of CNS tumours

  • IMPAIRED CONSCIOUSNESS AND NON-TRAUMATIC COMA

    • The aetiology, pathophysiology and differential diagnosis of altered consciousness and coma due to: meningitis, encephalitis, intracranial haemorrhage, acutely raised ICP, hydrocephalus, hypoxaemia and ischaemia, cardiogenic shock, hypoglycaemia, epilepsy, metabolic encephalopathies, drugs and toxins
    • Treatment of seizures
    • Planning and interpreting scans and other investigations

  • HEADACHE - ACUTE AND CHRONIC

    • The aetiology and differential diagnosis of acute and chronic headache including headache associated with: benign headache syndromes, migraine, cluster headache and related syndromes, space occupying lesions, meningitic disorders, intracranial haemorrhage, trigemminal neuralgia, atypical craniofacial pain syndrome
    • Indications for investigation including scanning, lumbar puncture and angiography
    • Interpretation of scans and other investigations

  • WEAKNESS AND PARALYSIS

    • Common causes of ocular, cranial nerve, limb, trunk and respiratory muscle weakness
    • Interpretation of scans and other investigations

  • DIZZINESS, UNSTEADINESS AND FALLS

    • Common causes of cerebellar, vestibular, extrapyrammidal and autonomic dysfunction
    • Interpretation of scans and other investigations

  • PAIN AND SENSORY LOSS

    • Common causes of musculoskeletal, neurogenic and neuropathic pain and sensory loss
    • Interpretation of scans and other investigations

  • HEARING DISORDER

    • Common causes of conductive and sensorineural hearing loss
    • Principles of audiological assessment
    • Interpretation of scans
    • Interpretation of pure tone audiograms and auditory evoked potentials

  • VISUAL DISORDER

    • Patterns of visual loss in relation to common bulbar, retrobulbar, sellar, parasellar and optic pathway disorders
    • Analysis of diplopia and nystagmus in relation to common cranial nerve and brainstem disorders
    • Interpretation of scans and other investigations

  • LANGUAGE AND SPEECH DISTURBANCE

    • Classification, causes and presentations of dysphasias, speech dyspraxia and dyslexia
    • Classification, causes and presentations of dysarthria
    • Role of speech and language therapists in assessment and treatment
    • 4 Interpretation of scans and other investigations

  • SWALLOWING DISORDERS

    • Neurological causes of dysphagia
    • Indications for laryngoscopy, videofluoroscopy, nasogastric and percutaneous gastric feeding
    • 4 Interpretation of scans and other investigations

  • DISORDERS OF THE SPHINCTERIC AND SEXUAL FUNCTION

    • Common causes of sphincteric and sexual dysfunction
    • Interpretation of urodynamic studies
    • 4 Interpretation of scans and other investigations

  • MOVEMENT DISORDER

    • Parkinson's disease
    • Iatrogenic movement disorders
    • Dystonic syndromes
    • Choreiform syndromes
    • The aetiology and pathophysiology of movement disorders
    • Indications for medical, minimally-invasive and surgical management
    • Complications of surgery and their management
    • Interpretation of scans and other investigations

  • MEMORY AND COGNITIVE DISORDERS

    • Disorders of memory and cognition associated with head injury, subarachnoid haemorrhage, hydrocephalus, structural lesions of the frontal and temporal lobes and disorders of the limbic system
    • Interpretation of scans and other investigations

  • BEHAVIOURAL DISORDERS

    • The common acute and chronic presentations of organic and psychiatric behavioural disorders relating to alcohol and drug abuse, encephalitis, organic dementia, and psychosis
    • 4 Interpretation of scans and other investigations

  • GENERAL MANAGEMENT OF THE HEAD INJURED PATIENT

    • Pathophysiology of head injury and of multiple trauma including an understanding of: Cerebral perfusion and oxygenation, Raised intracranial pressure, Impaired intracranial compliance, Intracranial herniation
    • Medical management of acutely raised intracranial pressure
    • Indications for operation intervention including the use of pressure monitoring
    • Principles, diagnosis and confirmation of brain death
    • Principles of intensive care of head injured patients
    • Principles of spinal stabilisation and radiological assessment in head injured patients
    • Natural history of recovery from head injury including neurological, cognitive and behavioural disability and post- traumatic epilepsy
    • Role of neurological rehabilitation
    • Pathophysiology of head injury and of multiple trauma
    • Prevention of secondary insults
    • Indications for operative intervention
    • Interpretation of CT scans and plain radiology

  • INSERTION OF ICP MONITOR

    • Indications for ICP monitoring
    • Applied anatomy of the skull vault
    • Potential complications of the procedure
    • Calibration, zeroing and interpretation of ICP traces

  • BURR HOLE EVACUATION OF CHRONIC SUBDURAL HAEMATOMA

    • Pathophysiology of chronic subdural haematomas
    • Applied anatomy of the skull vault and subdural space
    • Indications for surgery
    • Surgical options
    • Complications of surgery
    • Management of anti-platelet and anti-coagulant medication
    • 3 Interpretation of CT scans

  • MANAGEMENT OF SOFT TISSUE TRAUMA

    • Anatomy and blood supply of the scalp
    • Indications for primary and secondary closure of wounds
    • Indications for antibiotic prophylaxis

  • GENERAL MANAGEMENT OF SUBARACHNOID HAEMORRHAGE

    • Aetiology of SAH
    • Pathophysiology of SAH
    • WFNS grading of SAH
    • Principles of resuscitation and timing of interventions
    • Indications for CT scanning, diagnostic lumbar puncture, CT angiography and digital subtraction angiography
    • Principles of management of post-haemorrhagic hydrocephalus
    • Indications for endovascular and surgical intervention
    • Interpretation of CT scans including assessment of intracranial blood load, haematomas and hydrocephalus
    • Basic interpretation of cerebral angiography

  • DIAGNOSTIC LUMBAR PUNCTURE

    • Pathophysiology of delayed cerebral ischaemia including the impact of secondary insults
    • Principles governing the augmentation of cerebral blood flow
    • Interpretation of CT scans

  • MANAGEMENT OF POST-HAEMORRHAGIC HYDROCEPHALUS

    • Pathophysiology of hydrocephalus
    • Indications for external ventricular drainage and lumbar subarachnoid drainage
    • Applied anatomy of the skull vault, subdural space and ventricular system
    • Complications of surgery
    • Interpretation of CT scans

  • ADULT HYDROCEPHALUS

    • The pathophysiology of CSF circulation
    • Applied surgical anatomy of the ventricular system
    • Indications for external ventricular drainage, ventriculoperitoneal shunting, lumbar CSF drainage and shunting, ventriculo- cisternostomy
    • Complications of surgery
    • Surgical complications and their management
    • Interpretation of CT and MRI scans and identification of shunt malfunction

  • ASSESSMENT AND PERI-OPERATIVE MANAGEMENT OF PATIENTS WITH SPACE-OCCUPYING INTRACRANIAL TUMOURS

    • The neuropathology of primary and secondary intracranial tumours including: classification, epidemiology, natural history
    • Clinical presentations of intracranial tumours
    • Indications for neuroimaging
    • Management of raised intracranial pressure
    • Principles of operative management
    • Detection and management of post-operative complications
    • Basic interpretation of CT and MRI scans

  • IMAGE-GUIDED BIOPSY OF INTRACRANIAL TUMOUR

    • Indications for biopsy of intracranial tumours
    • Risks of biopsy
    • Principles of image-guided surgery
    • Interpretation of CT and MRI scans and selection of biopsy targets

  • ACUTE SPINAL DISORDERS

    • The assessment and peri-operative management of patients presenting with spinal cord, cauda equina and spinal root compression
    • The management of spinal shock
    • The ward management of patients with spinal instability
    • The detection and initial management of post-operative complications including compressing haematomas, CSF fistula and spinal sepsis

  • SURGICAL MANAGEMENT OF CRANIAL TRAUMA

    • Pathophysiology of raised intracranial pressure and space occupying haematomas
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Indications for surgery and appropriate surgical approaches
    • Interpretation of trauma CT scans

  • NEURO-INTENSIVE CARE OF THE HEAD-INJURED PATIENT

    • Pathophysiology of head injury
    • The management of raised intracranial pressure, impaired intracranial compliance, and cerebral ischaemia
    • Prevention and management of secondary insults
    • Interpretation of CT scans

  • NEUROLOGICAL REHABILITATION

    • The natural history of recovery from head injury
    • Understanding of neurological, cognitive and behavioural disabilities following mild and severe head injury
    • Risks of post-traumatic epilepsy and its management

  • PRIMARY INTRACEREBRAL HAEMATOMAS

    • Aetiology of supra and infratentorial intracerebral haemorrhage
    • Pathophysiology of spontaneous intracerebral haemorrhage
    • Indications for surgical evacuation
    • Management strategies to reduce the risk of intra-operative re-bleeding in presence of suspected aneurysm or AVM including partial haematoma evacuation, pre or post-operative embolisation and definitive surgical treatment
    • Interpretation of CT and MRI scans and identification of probable aetiology

  • ANEURYSMAL SUBARACHNOID HAEMORRHAGE

    • Pathophysiology of SAH
    • Prevention and management of delayed cerebral ischaemia, cerebral vasospasm and hydrocephalus
    • Relative indications for endovascular and surgical interventions

  • PAEDIATRIC HYDROCEPHALUS

    • The pathophysiology of CSF circulation
    • Applied surgical anatomy of the ventricular system
    • Indications for external ventricular drainage
    • Indications for external ventricular drainage, lumbar CSF drainage and shunting, ventriculo-cisternostomy
    • 4 Indications for VP and VA shunting and
    • 4 Principles of shunt function and selection
    • 4 Surgical complications and their management
    • Interpretation of CT scans in shunted children

  • GENERAL PRINCIPLES OF NEURO-ONCOLOGY

    • Classification, natural history and pathology of benign and malignant intracranial neoplasia
    • Pathophysiology of raised intracranial pressure associated with space occupying tumours
    • Diagnostic imaging of intracranial tumours including the interpretation of CT and MRI scans and the role of MRS
    • Principles of fractionated radiotherapy, stereotactic radiotherapy and radiosurgery
    • Role of adjuvant chemotherapy
    • Principles of clinical trials and their application to neuro-oncology
    • Principles of palliative care

  • PRINCIPLES OF IMAGE-GUIDED SURGERY

    • An understanding of the principles and practice of frameless image-guided surgery and the principles of frame-based stereotactic surgery
    • Interpretation of CT and MRI scans

  • SUPRA-TENTORIAL INTRINSIC TUMOURS

    • Indications for surgery
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery

  • CONVEXITY MENINGIOMA

    • Indications for surgery
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery

  • GENERAL MICROBIOLOGICAL PRINCIPLES

    • The pathophysiology of intracranial and spinal sepsis
    • Principles of anti-microbial chemotherapy
    • Indications for operative intervention
    • Interpretation of CT and MRI scans

  • MANAGEMENT OF INTRACEREBRAL ABSCESS

    • Indications for surgery
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery

  • MANAGEMENT OF THE SPINAL INJURY PATIENT

    • Pathophysiology of spinal cord injury
    • Classification of spinal fracture dislocations
    • Biomechanics of spinal instability
    • Indications for halo traction and external stabilisation
    • Indications for and principles of open reduction and stabilisation
    • Interpretation of plain radiology, CT and MRI scans

  • MALIGNANT SPINAL CORD COMPRESSION

    • The pathophysiology of spinal cord compression
    • The classification, aetiology and natural history of vertebral metastases
    • Spinal instability associated with vertebral malignancy
    • Indications for surgical intervention
    • Role of primary radiotherapy and adjuvant radiotherapy or chemotherapy
    • Indications for percutanous and open spinal biopsy
    • Indications for spinal decompression with and without instrumented spinal stabilisation
    • Interpretation of plain radiology, CT and MRI scans

  • SURGICAL MANAGEMENT OF THORACO-LUMBAR METASTASES

    • Indications for surgery
    • The principles of operative spinal decompression and stabilisation of patients with spinal cord metastases
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery

  • LUMBAR RADICULOPATHIES

    • Indications for operative management of lumbar radiculopathies
    • Applied surgical anatomy of the lumbar spine with particular reference to degenerative neural compression and morphological variations in vertebral anatomy
    • Selection of minimally-invasive approaches
    • Principles of peri-operative care
    • Complications of surgery
    • Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms

  • COMPRESSIVE CERVCAL MYELORADICULOPATHIES

    • Indications for operative management of cervical myeloradiculopathies
    • Applied surgical anatomy of the cervical spinal column with particular reference to the relationships between the bony elements, spinal cord, nerve roots and vertebral arteries
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery
    • Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms

  • MANAGEMENT OF HEAD-INJURED PATIENTS

    • Pathophysiology of raised intracranial pressure and space occupying haematomas
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Indications for surgery and appropriate surgical approaches
    • Indications for open and endoscopic closure of traumatic CSF fistulae
    • Complications of surgery and their management

  • ANTERIOR AND MIDDLE FOSSA SKULL BASE TUMOURS

    • Indications for selected approaches in relation to pathology and surgical goals
    • Applied microsurgical anatomy of the anterior and middle cranial fossae
    • Principles of intra-operative management of patients undergoing resection of anterior and middle fossa tumours including olfactory groove, planum sphenoidale, parasellar and sphenoid wing and falcine meningiomas
    • Complications of surgery and their management
    • Interpretation of CT and MRI scans

  • TRANSPHENOIDAL SURGERY

    • Pathophysiology of the hypothalamic-pituitary axis
    • Indications for surgery
    • Applied surgical anatomy of the skull base
    • Principles of peri-operative care
    • Complications of surgery and their management
    • Interpretation of CT and MRI scans
    • Selection of surgical approaches: sublabial, transnasal and endoscopic

  • MIDLINE TUMOURS

    • Indications for surgery
    • Selection of surgical approaches
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery and their management
    • Interpretation of CT and MRI scans

  • MAILIGNANT POSTERIOR FOSSA TUMOURS

    • Indications for surgery
    • Selection of surgical approaches
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery and their management
    • Interpretation of CT and MRI scans

  • CEREBELLOPONTINE ANGLE TUMOURS

    • Relative indications for surgery, radiosurgery and conservative management
    • Principles of intra-operative management of patients undergoing resection of CP angle tumours including vestibular schwannomas and menignomas
    • Applied microsurgical anatomy of the CP angle, brainstem and lower cranial nerves
    • Relative indications for retrosigmoid, middle fossa, and translabyrinthine approaches with respect to hearing preservation, tumour size and position
    • Principles and application of cranial nerve and brainstem monitoring

  • INTRACEREBRAL ABSCESS AND SUBDURAL EMPYEMA

    • The aetiology and pathophysiology of intracranial sepsis
    • Indications for burr hole drainage, ventricular drainage and craniotomy in the management of intracranial sepsis
    • Indications for combined otorhinological procedures
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Surgical complications
    • Interpretation of CT and MRI scans

  • INTRACRANIAL ANEURYSMS

    • Aetiology, epidemiology and natural history of unruptured and ruptured intracranial aneurysms
    • Pathophysiology and general management of subarachnoid haemorrhage
    • Angiographic and microsurgical anatomy of the cerebral circulation
    • Indications for surgical management of intracranial aneurysms by clipping, trapping, microsurgical reconstruction and microvascular bypass
    • Complications of surgery and their management
    • Interpretation of CT, MR and catheter angiography

  • INTRACRANIAL VASCULAR MALFORMATIONS

    • Pathogenesis, aetiology, epidemiology and natural history of intracranial vascular malformations including AVMs, A-V fistula, cavernomas and venous malformations
    • Pathophysiology and general management of intracranial haemorrhage
    • Angiographic and microsurgical anatomy of the cerebral circulation
    • Indications for embolisation and radiosurgery
    • Indications for surgical management of malformations
    • Interpretation of CT, MR and catheter angiography
    • Complications of surgery and their management, including hyperperfusion syndromes

  • OCCLUSIVE CEREBROVASCULAR DISEASE

    • The epidemiology, natural history and pathophysiology of extra- and intracranial atherosclerotic occlusive disease
    • The epidemiology, natural history and pathophysiology of non-atherosclerotic occlusive diseases
    • Optimal medical management of occlusive and thrombo-embolic cerebrovascular disease
    • Imaging of the acutely ischaemic brain using CT and MRI
    • Principles of non-invasive and invasive imaging of the extra and intracranial vasculature using CT, MRI and catheter angiography
    • Principles of regional cerebral blood flow and metabolism measurement and imaging using CT and MRI perfusion techniques; SPECT and PET scanning
    • Indications for carotid endarterectomy
    • Indications for endovascular intervention including intra-arterial thrombolysis; carotid angioplasty and stenting; intracranial angioplasty
    • Principles of cerebral revascularisation by indirect synangiosis, low-flow EC-IC anastomosis and high flow EC-IC bypass grafting
    • Interpretation of CT, MR and catheter angiography

  • CHRONIC PAIN

    • Aetiology, epidemiology and natural history of trigeminal neuralgia
    • Differential diagnosis and management of related cranio-facial pain syndromes
    • Medical management of cranio-facial pain
    • Surface anatomy of the trigemminal nerve and microsurgical anatomy of the CP angle
    • Indications for surgical management of trigeminal neuralgia by peripheral neurectomy, percutaneous rhizotomy, radiofrequency rhizotomy, microvascular decompression
    • Complications of surgery and their management
    • Interpretation of posterior fossa CT and MRI scans

  • EPILEPSY

    • The aetiology and pathophysiology of idiopathic and lesional epilepsy
    • Indications for medical and surgical management
    • Interpretation of CT, MRI and SPECT scans

  • CERVICAL SPINE FRACTURE-SUBLUXATION

    • Pathophysiology of spinal cord injury
    • Classification of cervical spinal fracture dislocations
    • Biomechanics of spinal instability
    • Indications for halo traction and external stabilisation
    • Indications for and principles of open reduction and stabilisation
    • Interpretation of plain radiology, CT and MRI scans

  • THORACO-LUMBAR FRACTURES

    • Pathophysiology of spinal cord injury
    • Classification of thoracolumbar fracture dislocations
    • Biomechanics of spinal instability
    • Indications for open reduction and stabilisation
    • Interpretation of plain radiology, CT and MRI scans

  • INTRADURAL EXTRAMEDULLARY TUMOURS

    • Classification, natural history and basic molecular biology of intradural spinal tumours
    • Pathophysiology of spinal cord compression
    • Indications for surgery
    • Selection of surgical approaches
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery and their management
    • Interpretation of spinal MRI scans

  • INTRAMEDULLARY SPINAL CORD TUMOURS

    • Classification, natural history and pathology of intramedullary spinal cord tumours
    • Indications for biopsy, subtotal and radical excision
    • Role of adjuvant treatment
    • Applied surgical anatomy of spine and spinal cord
    • Selection of surgical approaches
    • Principles of intra-operative management of patients undergoing resection of intramedullary tumours
    • Complications of surgery and their management
    • Interpretation of spinal MRI scans

  • CERVICAL MYELORADICULOPATHY

    • Indications for operative management of cervical radiculopathies
    • Applied surgical anatomy of the cervical spinal column, spinal cord, nerve roots and vertebral arteries
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery
    • Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms

  • RHEUMATOID DISEASE

    • The pathology and natural history of rheumatoid spondylopathy
    • Indications for operative management of atlanto-axial subluxation, cranial settling and related disorders
    • Applied surgical anatomy of the craniocervical junction
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery
    • Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms and 3D spinal reconstructions

  • HINDBRAIN HERNIATION

    • The pathogenesis and natural history of hindbrain herniation, cranicervical stenosis, syringomyelia and syringobulbia
    • Indications for foramen magnum decompression
    • Applied surgical anatomy of the craniocervical junction
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery
    • Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms and 3D spinal reconstructions

  • SPINAL EPIDURAL ABSCESS

    • The aetiology and pathophysiology of spinal sepsis
    • Indications for drainage of spinal epidural abscess by laminectomy and multiple laminotomies
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Surgical complications and their management
    • Interpretation of spinal CT and MRI scans

  • VERTEBRAL OSTEOMYELITIS AND DISCITIS

    • The aetiology and pathophysiology of vertebral osteomyelitis and discitis, including pyogenic, tuberculous and atypical infections
    • Indications for percutaneous and open biopsy
    • Indications for spinal stabilisation
    • Principles of peri-operative care
    • Surgical complications and their management
    • Interpretation of spinal CT and MRI scans

  • CARPAL TUNNEL COMPRESSION

    • Presentation, differential diagnosis and management of carpal tunnel syndrome
    • Interpretation of nerve conduction studies
    • Indications for surgery
    • Applied surgical anatomy

  • ULNAR NEUROPATHY

    • Presentation, differential diagnosis and management of ulnar neuropathies
    • Interpretation of nerve conduction studies
    • Indications for surgery
    • Applied surgical anatomy

  • PERIPHERAL NERVE SHEATH TUMOURS

    • Pathology of peripheral nerve sheath tumours
    • Indications for complete and subtotal resection of tumours
    • Applied surgical anatomy of the major peripheral nerves

  • PAEDIATRIC HEAD AND SPINAL INJURY

    • Pathophysiology of raised intracranial pressure in children following head injury
    • Prevention and treatment of secondary insults relating to transfer and emergency surgery in head-injured children
    • Medical management and intensive care in paediatric head injury
    • Pathophysiology, legal and social aspects of non-accidental injury in children
    • Management of perinatal trauma, growing fractures and penetrating injuries in children
    • Indications for decompressive craniectomy in management of intractable increases in ICP
    • Rehabilitation after mild, moderate and severe head injuries
    • Diagnosis and certification of brain death in children
    • Classification, assessment, investigation and management of paediatric spinal injuries (including SCIWORA)
    • Understanding of the legal issues surrounding non-accidental injury

  • INTRACRANIAL VASCULAR DISORDERS

    • Epidemiology, natural history, pathophysiology and clinical features of subarachnoid haemorrhage, haemorrhagic stroke and ischaemia stroke in children secondary to intracranial aneurysms, arteriovenous malformations and fistulae, cavernomas, arterial dissection, moya-moya disease and venous sinus thrombosis
    • Surgical and endovascular strategies for the management of acute intracranial vascular disorders in children
    • Surgical, endovascular and radiosurgical strategies for the management of intracranial vascular disorders in children
    • Consent issues in children

  • PAEDIATRIC NEURO-ONCOLOGY

    • Epidemiology, natural history and pathology of tumours of the central nervous system in children including medulloblastoma, pilocytic astrocytoma, high grade gliomas, supratentorial PNET, pineal region tumours, brain stem tumours and intramedullary spinal cord tumours
    • Imaging of paediatric CNS tumours
    • Radiological and biochemical staging of tumours
    • Indications for surgery, radiotherapy, primary and adjuvant chemotherapy
    • Goals of surgery
    • Long-term effects of treatment on cognition, hypothalamic-pituitary function and quality of life
    • Availability of clinical (CCLG) trials
    • Management of delayed spinal deformity associated with treatment of spinal cord tumours
    • Assessment and clinical management of children with tumours of the central nervous system
    • Consent issues in children

  • HYDROCEPHALUS

    • Pathophysiology and investigation of abnormal CSF dynamics in hydrocephalus and BIH
    • Indications for third ventriculostomy and for shunt insertion
    • Principles of shunt design and function
    • Antenatal diagnosis of hydrocephalus and its prognosis
    • Medical and ophthalmological treatment options for BIH
    • Interpretation of CT, MRI scans and ultrasound scans

  • CONGENITAL SPINAL DISORDERS

    • Embryogenesis of craniospinal dysraphism
    • Pathophysiology of CSF circulation associated with hindbrain hernia, syringobulbia and syringomyelia
    • Epidemiogy, natural history and clinical features of congenital spinal disorders including dysraphism, tethered cord syndrome, diastematomyelia, Chiari malformations, Klippel-Feil syndrome, achondroplasia, Downs syndrome etc
    • Imaging of the neonatal and growing paediatric spine of children with congenital disorders commonly
    • Antenatal diagnosis of dysraphism and its implications
    • Consent issues in children

  • CRANIOFACIAL DISORDERS

    • Advances in the genetic understanding of craniofacial conditions
    • Epidemiology, natural history and clinical features of simple and syndromic craniosynostosis including cosmetic, cognitive and ophthalmological complications
    • Imaging of simple and syndromic craniosynostosis
    • Indication for and timing of surgical interventions
    • Understanding of causes and management of positional plagiocephaly
    • Epidemiology, natural history, and clinical features of common skull vault conditions including eosinophilic granuloma, fibrous dysplasia etc

  • PAEDIATRIC EPILEPSY

    • Classification, epidemiology, natural history and clinical features of epilepsy in childhood
    • Clinical, encephalographic, videotelemetric and radiological assessment of children entering a surgical program
    • Indications for, prognosis and complications of VNS, disconnection procedures and temporal lobe surgery
    • Consent in children

  • SPASTICITY AND MOVEMENT DISORDERS

    • Clinical presentations of spasticity and other movement disorders in childhood
    • Multi-disciplinary assessment of children entering a surgical program
    • The indications for, prognosis and complications of intrathecal baclofen therapy, dorsal rhizotomy and deep brain stimulation in the management of spasticity and dystonia
    • Awareness of indications for CNS modulating procedures in the management of pain and convulsive disorders

  • ADVANCED SURGICAL TECHNIQUES

    • Indications for; applications of; advantages and disadvantages of various advanced surgical approaches and adjuncts

  • LOW-GRADE INTRINSIC TUMOURS

    • Epidemiology, natural history, genetic characteristics, pathology and clinical features of low grade intrinsic cerebral tumours
    • Surgical and non-surgical management options for low grade intrinsic tumours
    • Interpretation of CT, MRI and functional imaging in patients with low grade intrinsic tumours

  • TUMOURS OF THE VENTRICULAR SYSTEM AND PINEAL

    • Epidemiology, natural history, genetic characteristics, pathology and clinical features of intraventricular and pineal region tumours
    • Radiological and biochemical staging
    • Surgical and non-surgical management options for low grade intrinsic tumours
    • Surgical anatomy relevant to approaches to the lateral and third ventricles and the pineal region

  • BRAINSTEM TUMOURS

    • Epidemiology, natural history, genetic characteristics, pathology and clinical features of brain stem tumours
    • Management options for patient with brainstem tumours including open surgery, biopsy and radiotherapy

  • RADIOSURGERY AND STEREOTACTIC RADIOTHERAPY

    • The principles of radiosurgery and stereotactic radiotherapy
    • The indications for their use as adjunctive and/or primary treatment modalities

  • SURGICAL MANAGEMENT OF PAIN

    • The aetiology and pathophysiology of chronic pain syndromes
    • Indications for medical, minimally-invasive and surgical management
    • Applied surgical anatomy
    • Complications of surgery and their management

  • NEUROVASCULAR COMPRESSION SYNDROMES

    • Aetiology, epidemiology and natural history of trigeminal neuralgia, and glossopharyngeal neuralgia
    • Differential diagnosis and management of related cranio-facial pain syndromes
    • Medical management of cranio-facial pain
    • Surface anatomy of the trigeminal nerve and microsurgical anatomy of the CP angle
    • Indications for surgical management of trigeminal and glossopharyngeal neuralgia by peripheral neurectomy, percutaneous rhizotomy, radiofrequency rhizotomy, microvascular decompression
    • Complications of surgery and their management
    • Interpretation of posterior fossa CT an MR and scans including MR sequences demonstrating neurovascular compression

  • SPASTICITY

    • The aetiology and pathophysiology of spasticity
    • Indications for medical, minimally-invasive and surgical management
    • Applied surgical anatomy
    • Complications of surgery and their management

  • EPILEPSY

    • The pathophysiology of idiopathic and lesional epilepsy
    • Indications for medical and surgical management
    • Principles of ictal, interictal, sphenoidal and intraoperative EEG
    • Principles of video-EEG monitoring
    • Applied surgical anatomy
    • Complications of surgery and their management
    • Interpretation of CT, MRI and SPECT scans

  • MOVEMENT DISORDERS

    • The aetiology and pathophysiology of movement disorders
    • Indications for medical, minimally-invasive and surgical management
    • Applied surgical anatomy
    • Complications of surgery and their management
    • Interpretation of CT and MRI scans

  • SURGERY FOR MENTAL ILLNESS

    • Indications for surgical treatment of mental illness
    • Ethical and regulatory aspects of surgical treatment of mental illness
    • Surgical targets

  • ITNTRACRANIAL ANEURYSMS

    • The epidemiology, natural history, aetiology and pathophysiology of unruptured and ruptured intracranial aneurysms
    • Vascular anatomy of the central nervous system
    • Indications for surgical and endovascular treatment of intracranial aneurysms
    • The principles of endovascular treatment
    • Indications for intra and extracranial bypass in the management of complex aneurysms

  • INTRACRANIAL ARTERIOVENOUS MALFORMATIONS

    • The epidemiology, classification, natural history, embryogenesis and pathophysiology of AVMs of the brain
    • The indications for surgical, radiosurgical and endovascular treatment of asymptomatic, symptomatic and ruptured brain AVMs

  • INTRACRANIAL DURAL ARTERIOVENOUS FISTULAE

    • Applied anatomy of the cerebral venous circulation
    • The epidemiology, classification, natural history, pathogenesis and pathophysiology of intracranial dAVFs
    • The indications for surgical and endovascular treatment of asymptomatic, symptomatic and ruptured intracranial dAVFs

  • CEREBRAL ISCHAEMIA

    • The epidemiology, natural history and pathophysiology of extra- and intracranial atherosclerotic occlusive disease
    • The epidemiology, natural history and pathophysiology of non-atherosclerotic occlusive diseases
    • Optimal medical management of occlusive and thrombo-embolic cerebrovascular disease
    • Imaging of the acutely ischaemic brain using CT and MRI
    • Principles of non-invasive and invasive imaging of the extra and intracranial vasculature using ultrasound, transcranial Doppler, CT, MRI and catheter angiography
    • Principles of regional cerebral blood flow and metabolism measurement and imaging using CT and MRI perfusion techniques; SPECT and PET scanning
    • Indications for carotid endarterectomy
    • Indications for endovascular intervention including intra-arterial thrombolysis; carotid angioplasty and stenting; intracranial angioplasty
    • Principles of cerebral revascularisation by indirect synangiosis, low-flow EC-IC anastomosis and high flow EC-IC bypass grafting

  • CRANIAL BASE MENINGIOMAS

    • Epidemiology, natural history, pathology and clinical presentation of meningiomas of the anterior, middle and posterior fossae
    • Indications for radical or subtotal resection of skull-base meningiomas
    • Indications for radiosurgical treatment
    • Applied surgical anatomy of the skull base and craniofacial skeleton
    • Selection of optimal approaches in relation presenting pathology and imaging

  • PITUITARY AND SELLAR REGION TUMOURS

    • Classification, epidemiology, natural history, pathology and clinical presentation of tumours of the pituitary and sellar region
    • Pathophysiology of the hypothalamic-pituitary axis
    • Investigation of the hypothalmic pituitary axis in patients with hypopituitarism and hypersecretion syndromes
    • Indications for surgery, radiosurgery and adjuvant radiotherapy
    • Selection of surgical approaches: sublabial, transnasal and endoscopic
    • Applied surgical anatomy of the skull base
    • Principles of peri-operative care
    • Complications of surgery and their management

  • ACOUSTIC NEUROMAS

    • Epidemiology, natural history, pathology and clinical presentation of sporadic and NFII-related acoustic neuromas Relative indications for surgery, radiosurgery and conservative management
    • Principles of intra-operative facial nerve and BAEP monitoring
    • Applied microsurgical anatomy of the CP angle, brainstem and lower cranial nerves
    • Relative indications for retrosigmoid, middle fossa, and translabyrinthine approaches with respect to hearing preservation, tumour size and position

  • OTHER SKULL-BASE TUMOURS

    • Epidemiology, natural history, pathology and clinical presentation of benign and malignant tumours of the skull base including cranial nerve schwannomas, chordomas, paragangliomas, adenoid cystic carcinomas, angiofibromas and nasopharyngeal carcinomas
    • Indications for radical or subtotal resection of skull-base tumours
    • Indications for radiosurgical treatment
    • Applied surgical anatomy of the skull base and craniofacial skeleton
    • Selection of optimal approaches in relation presenting pathology and imaging

  • CRANIOFACIAL REPAIR

    • Applied surgical anatomy of the cranial base floor and paranasal sinus
    • Indications for open surgical and endoscopic repair of spontaneous, post-traumatic and post-surgical skull base defects and CSF fistulae
    • Principles of simple, pedicled and free vascularised tissue transfer

  • SPINAL TRAUMA

    • Pathophysiology of spinal cord injury
    • Classification of cervical and thoracolumbar fracture dislocations
    • Biomechanics of spinal instability
    • Indications for halo traction and external stabilisation
    • Indications for and principles of open reduction and stabilisation
    • Applied surgical anatomy of cervical and thoracolumbar fracture-subluxations
    • Relative indications for operative reduction and stabilisation by anterior and posterior approaches
    • Management of post-traumatic spinal deformity and delayed sequelae

  • METASTATIC SPINAL DISEASE

    • The pathophysiology of spinal cord compression
    • The classification, aetiology and natural history of vertebral metastases
    • Spinal instability associated with vertebral malignancy
    • Indications for percutanous and open spinal biopsy
    • Role of primary radiotherapy and adjuvant radiotherapy or chemotherapy
    • Indications for spinal decompression with and without instrumented spinal stabilisation
    • Interpretation of plain radiology, CT and MRI scans

  • INTRADURAL TUMOURS

    • Classification, epidemiology, natural history and pathology of intradural spinal tumours
    • Pathophysiology of spinal cord compression
    • Indications for biopsy, subtotal and radical surgery
    • Selection of surgical approaches
    • Applied surgical anatomy
    • Principles of peri-operative care
    • Complications of surgery and their management
    • Role of adjuvant treatment

  • SYRINGOMYELIA AND HIND BRAIN ANOMALIES

    • The pathogenesis and natural history of hindbrain herniation, craniocervical stenosis, syringomyelia and syringobulbia
    • Indications for foramen magnum decompression
    • Applied surgical anatomy of the craniocervical junction
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery

  • ADVANCED SURGERY OF THE AGEING AND DEGENERATIVE SPINE

    • Techniques for operative stabilization of the osteoporotic spine
    • Principles of surgery for degenerative scoliosis
    • Biomechanical principles of and indications for cervical and lumbar disc replacement
    • Biomechanical principles of and indications for non-fusion spinal stabilisation
    • Indications for, techniques and complications of vertebroplasty and Kyphoplasty
    • Principles of thoracoscopic and laparoscopic surgical techniques

  • SURGERY OF THE RHEUMATOID SPINE

    • The pathology and natural history of rheumatoid spondylopathy
    • Indications for operative management of atlanto-axial subluxation, cranial settling and related disorders
    • Applied surgical anatomy of the craniocervical junction
    • Selection of surgical approaches
    • Principles of peri-operative care
    • Complications of surgery

How to prepare

Work through the topics, read the explanation after each answer, and revisit the areas where you miss questions. Use the official outline and reference materials below to guide your study.

These independent practice questions are not actual exam items and do not guarantee a passing result.

Frequently asked questions

What is the exam format?

Section 1 consists of two computer-based Single Best Answer papers taken on the same day at Pearson VUE test centres in the UK and Ireland. Section 2 clinical/oral assessment is separate and excluded.

How many questions are on the exam?

Total questions: 240.

How long is the exam?

2 hours 15 minutes per paper; 4 hours 30 minutes of answering time in total. This does not include check-in, tutorials or breaks.

What is the passing score?

Angoff standard setting at day-one consultant level; one standard error of measurement (SEM) is added to the cut score to set the pass mark, after review/removal of problematic items. No universal fixed percentage is specified by this procedure.

How much does the exam cost?

GBP: through 31 December 2026, Section 1 £580 (combined Section 1 and 2 entry £2,000); from 1 January 2027, Section 1 £600 (combined entry £2,070). The full combined amount is payable at initial online application and credited to the candidate fee account; resit fees are deducted from that account, with top-up required when insufficient.

Official sources and references

Confirm current exam arrangements with the exam provider.