BackgroundThe specialties chosen by medical students after graduation are critical to their professional trajectories. This study investigates the perceptions of medical students at Jazan University in southwestern Saudi Arabia toward neurosurgery, focusing on the factors that influence their inclination to pursue this specialty. MethodsAn observational cross-sectional study was conducted among 342 medical students from the Faculty of Medicine at Jazan University during the 2022–2023 academic year. The participants included students ranging from second- to sixth-year levels. ResultsAmong the 342 students, 207 (60.5 %) were males, and 135 (39.5 %) were females, with 169 (49.4 %) expressing interest in neurosurgery. Over time, there was a trend of decreasing interest in neurosurgery. The primary reasons for choosing this specialty were market demand for neurosurgeons and potential for substantial income, while stress was the main deterrent. Multivariate analysis revealed that third-, fourth-, and fifth-year students were significantly less likely to pursue neurosurgery, with reductions of 89 % [OR=0.11, 95 % CI: (0.04–0.29), p < 0.001], 83 % [OR=0.17, 95 % CI: (0.07–0.43), p < 0.001], and 74 % [OR=0.26, 95 % CI: (0.11–0.61), p = 0.002], respectively. The strongest motivating factors for choosing neurosurgery were research opportunities [OR=2.37, p < 0.001] and the prestige associated with the specialty [OR=2.35, p < 0.001]. ConclusionsThe study provides valuable insights into medical students’ perceptions and career aspirations related to neurosurgery in southern Saudi Arabia. It highlights key factors such as research opportunities, prestige, and competitiveness that motivate students to consider neurosurgery as a specialty. The study also addresses common misconceptions and stereotypes about neurosurgery, promoting a more accurate understanding of the field among students. These findings have significant implications for medical education, career guidance, and healthcare policy, helping to shape initiatives that enhance patient care and support the development of neurosurgery.