Western Pennsylvania Medical College was founded in the Bloomfield district of Pittsburgh in 1886. It was connected by an underground tunnel to the Western Pennsylvania (West Penn) Hospital, where students did their clinical training. The students attended 14 clinical lectures per week in addition to observing medical and surgical interventions. Initially the degree took two years to obtain, but in 1896 the medical school became a four-year program. The annual fee was $100, and examinations were administered at the end of the biannual term. Similar to present-day medical school curricula, the first two years were spent primarily in the classroom, with the third and fourth years being clinically oriented.

In 1892, the Western Pennsylvania Medical College became affiliated with the Western University of Pennsylvania. This relationship grew stronger over the years, but financial resources and assets remained separate. In 1908, the Western University of Pennsylvania was renamed the University of Pittsburgh and relocated to Oakland, which then was a burgeoning cultural and educational center. The University of Pittsburgh and the board of trustees, under the chancellorship of Dr. Samuel Black McCormick, unified the graduate and professional schools into a single entity. The medical college abandoned its original building and moved to the new University complex in Oakland. It was at this time that the school's affiliation switched from West Penn Hospital to Presbyterian University Hospital.

Presbyterian Hospital, c. 1945

Neurological surgery in the city began in 1936 with the arrival of Stuart Niles Rowe, a promising young surgeon trained under the auspices of Charles H. Frazier in Philadelphia. Rowe's arrival marked the birth of a neurosurgical department that would become a leader in the field. His move here was prompted by a letter from Dr. L.H. Landon Sr., the chief of general surgery at West Penn Hospital, to Frazier in 1935, emphasizing the need for a formally trained neurosurgeon in Pittsburgh. It is said that Rowe, at the end of his residency, won a coin toss over William J. Gardner for the opportunity to migrate to the Pittsburgh area and set up practice. Gardner subsequently moved to the Cleveland area and developed his own neurosurgical center.

Rowe, a Michigan native, developed a strong clinical practice based on the loosely affiliated community hospitals in the Pittsburgh area. He focused his research activities at the University of Pittsburgh and wrote several pioneering papers on the neurosurgical treatment of pain, brain abscess, and cerebral trauma. An avid sportsman and devoted father, he dedicated at least one day a week to physical fitness and family life. Rowe began the first formal residency program at West Penn Hospital in 1949 and consolidated this program at Presbyterian University Hospital within the University of Pittsburgh in 1952. Another program was also established at Mercy Hospital in 1949 under the direction of Floyd Bragden, who arrived in Pittsburgh three years after Rowe. Bragden, trained by Jefferson Browder at Kings County Hospital, was a Pittsburgh native and a well-known acoustic tumor surgeon.

The first woman to practice neurosurgery in the area was Dr. Dorothy Klinke Nash. Having completed training in both neurology and neurosurgery at Bellevue Hospital under the guidance of Byron Stookey in the late 1920s, Nash moved to the Pittsburgh area in 1936 but did not gain hospital appointment until a chance meeting with Dr. Morris Abel Slocum, the chief of general surgery at St. Margaret Hospital. At the time, Nash worked at the blood bank. While drawing Slocum's blood, he determined Nash's background in neurosurgery and immediately appointed her to a staff position. This appointment was a landmark in that she became the first woman to practice neurosurgery in the United States and thereby pioneered the way for other women in the field. Shortly thereafter she was appointed to the hospital staff at the University under Rowe. A graduate of Bryn Mawr College and the Columbia College of Physicians and Surgeons, Nash was named Pennsylvania Woman of the Year in 1957.

Rowe volunteered for military service in World War II, served as an Army lieutenant colonel, and treated casualties triaged to a southern England military hospital. Upon return to Pittsburgh at the end of the war, he resumed control of the neurosurgery service at the University, which was then a division of General Surgery. With characteristic zeal and his newly acquired military background, Rowe embarked on a mission to unify the service, which performed operations at many local hospitals. He also began to train residents.

His own training firmly based in academic neurosurgery, Rowe sought to acquire residents with a commitment to research, teaching, and independent thought. The conference schedule included joint conferences with the Mercy Hospital neurosurgical program and a monthly journal club that convened after dinner at Rowe's home.

A key addition to the staff during this time was Dr. Anthony Fredrick Susen. Dr. Susen joined the department in 1953 as a clinical instructor after completing his training at both Bowman Gray Medical School and Harvard. The Illinois native graduated from Dartmouth College and Harvard Medical School. He held the same belief as Rowe: that residency training programs should be designed to teach not only exceptional surgical technique, but also the critical clinical decision-making skills needed for properly selecting patients who would benefit from neurosurgical intervention. Susen supported Rowe's beliefs in training residents and emphasized the need for thorough literature review and independent research as a means of broadening clinical knowledge.

Rowe and Susen worked together into the 1960s. In 1964, Dr. Henry Bahnson, the chair of General Surgery, appointed Dr. Sidney Goldring of St. Louis to be the first chief of the Division of Neurological Surgery. After two years, Goldring returned to St. Louis as a professor of neurosurgery and subsequently was named chairman at Washington University. In 1966, Susen was named acting chief and, under his direction, other facilities including Children's Hospital and the Veterans Administration Medical Center became part of the service. During the tenure of Rowe and Susen from 1952 to 1971, 19 neurosurgery residents trained at the University of Pittsburgh.

In 1971, the appointment of Dr. Peter Joseph Jannetta as professor and chairman of the newly formed Department of Neurological Surgery heralded the beginning of a new era. Jannetta completed both his undergraduate work and medical training at the University of Pennsylvania. He then finished a general surgery residency at Penn and spent a year as an NIH fellow in neurophysiology before beginning his neurosurgical training at UCLA. While at UCLA, Jannetta's research led to his hypothesis regarding vascular compression of the various cranial nerves. Based on Dr. Walter Dandy's initial observations of abnormal relationships between the trigeminal nerve and the surrounding vasculature, Jannetta hypothesized that vascular compression of a nerve may cause a variety of hypoactive and hyperactive cranial nerve syndromes. During his 25 years as chairman, he trained 49 residents. He was honored with an endowed professorship appropriately named after Walter E. Dandy. Although Jannetta's scientific contributions are significant, perhaps his greatest achievement is the legacy of outstanding international leaders he has trained in neurosurgery. From 1995 to 1996, Jannetta served as Secretary of Health of the Commonwealth of Pennsylvania.

In 1997, L. Dade Lunsford, MD, was selected as the second department chairman. A Virginia native, Dr. Lunsford completed his undergraduate education at the University of Virginia and medical school at the Columbia University College of Physicians and Surgeons. After finishing a general surgery internship at the University of Virginia Hospital, he joined the neurosurgery residency at the University of Pittsburgh under Dr. Jannetta in 1975. His training continued in 1980-1981 with a Van Wagenen Fellowship in stereotactic and functional neurosurgery at the Karolinska Institute under Dr. Erik-Olof Backlund. Dr. Lunsford then returned to Pittsburgh to develop the Center for Image-Guided Neurosurgery. In recognition of his efforts in stereotaxy and radiosurgery, he was given the endowed Lars Leksell Professorship in 1997. In the ensuing decade, Dr. Lunsford has guided the department to an elite position in the academic community. The department is widely regarded as one of the top academic neurosurgical departments in the country and was recently ranked second in the nation in NIH (National Institutes of Health) funding.

In June of 2006, Dr. Lunsford announced his decision to step down as department chair in order to devote more time to his clinical, research and resident education work. University of Pittsburgh School of Medicine dean, Arthur S. Levine, MD, appointed Amin Kassam, MD, associate professor of neurological surgery and co-director of the Minimally Invasive endoNeurosurgery Center, interim chairman of the department. Dr. Kassam was subsequently appointed chairman by Dr. Levine on May 2, 2007.

Dr. Kassam and his colleagues, Drs. Carl Snyderman and Ricardo Carrau of the Department of Otolaryngology, have refined endoscopic transnasal surgical techniques. Their ability to access the base of the skull through the nostril has revolutionized the surgical treatment of skull base tumors, arteriovenous malformations, aneurysms, and other lesions previously accessible only through craniotomy.