An historic event in Neurosurgery in Puerto Rico was the establishment of the Neurosurgical Residency Program at the School of Medicine of the Medical Sciences Campus of the University of Puerto Rico. In 1948 Dr.Nathan Rifkinson returned to Puerto Rico after finishing his neurosurgical residency training at Washington University in St. Louis. He was the only neurosurgeon on the Island until Dr. Luis Guzman came to Puerto Rico in 1950 after obtaining his residency at the New York Neurological Institute. It was at that time that the first School of Medicine was being established. Dr. Luis Guzman was appointed as Director of Neurosurgery. The number of neurosurgeons gradually increased in the following years and all became faculty members of our yet-non-recognized neurosurgery section. During this period the neurosurgical faculty taught the succeeding classes of medical students.

Dr. Guzman tried to create a residency program in Neurosurgery, but his efforts were unsuccessful. In 1970 Dr. Rifkinson and Dr. Alvarez de Choudens contacted Dr. Henry Schwartz of Washington University, who was president of the American Association of Neurological Surgeons at the time. Dr. Schwartz sent Dr. Guy Odom, Neurosurgery Director at Duke University and Dr. Garber Galbraith Director of Neurosurgery at the University of Alabama, to Puerto Rico. They reported the great need for a residency program for Puerto Rico to the Council of the AANS. A local committee selected Dr. Alvarez de Choudens as the Chief of Neurosurgery in 1971. In 1973 Governor Rafael Hernandez Colon appointed Dr. Alvarez de Choudens Secretary of Health of Puerto Rico. Dr. Nathan Rifkinson was then appointed the next Director of Neurosurgery, which he held until 2002. During his tenure 31 residents were trained. Approximately one third migrated to the United States and are doing very well. Most of the remaining graduated residents have become the faculty members of our neurosurgical program or are in private practice providing direct medical care to the Puerto Rican people. Dr. Ricardo Brau Ramirez succeeded Dr. Rifkinson until May 2011. Tthe present Director of Neurosurgery is Dr. Juan Vigo Prieto.