The history, transatlantic legacy and current state of neurosurgery in Plymouth, England.

PURPOSE: This article examines the history, transatlantic legacy, and current state of neurosurgery in Plymouth, England. It explores how the South West Neurosurgical Centre, founded in 1964, evolved from a regional unit into a major hub for neurosurgical care, innovation and training, including a long-standing training partnership with the University of Virginia (UVA). MATERIALS AND METHODS: Primary sources were drawn from the Cottonian Research Room of the Plymouth Archive at The Box Museum, operative logbooks, departmental newsletters, and photographic records. Additional source material included the SBNS Newsletter, published obituaries, a Hansard parliamentary debate, and contemporaneous press reports. Oral histories from former consultants were incorporated where documentary evidence was incomplete. RESULTS: The department's early years were shaped by the challenges of limited infrastructure and reliance on itinerant neurosurgical services. The appointment of Henry Gossman in 1964 marked a turning point, with rapid expansion in admissions and the establishment of structured head injury care across Devon and Cornwall. A defining feature was the transatlantic training programme initiated in 1970 with UVA, which brought 39 American residents to Plymouth over three decades, many of whom went on to lead academic neurosurgical programmes in the United States. Locally, the department advanced subspecialisation, introduced image-guided surgery, and developed strong collaborations with radiology and anaesthesia. Since relocating to Derriford Hospital in 1986, the Centre has expanded to serve a population of nearly two million, performing approximately 2,000 operations annually and contributing to national clinical trials. CONCLUSIONS: The history of neurosurgery in Plymouth provides a case study in the regionalisation of specialist surgical care, the growth of consultant-led neurosurgical services outside metropolitan centres, and the development of international training networks. Its partnership with UVA was a distinctive example of transatlantic neurosurgical education, while its later expansion reflects broader changes in UK neurosurgery, including subspecialisation, multidisciplinary working, and academic integration.