Innovation in medicine has led to advances directly benefitting patients. Yet recent legislation has created intense scrutiny of the relationship between surgeons and industry. Critics argue that surgeon-held patents and royalties incentivize surgeon loyalty, influencing decision making as to which devices are used intraoperatively. We explored the potential for inventor-related conflicts of interest. We searched patent records from the United States Patent and Trademark Office for every diplomate recognized by the American Board of Neurological Surgeons (4868 neurosurgeons). We also searched physician payment registries of the 5 largest device makers; of these, Medtronic, DePuy, and Zimmer were the only companies with available registries. A total of 147 neurosurgeons (3.0%) hold a total of 582 patents; the number of patents held per neurosurgeon ranges from 1 to 53. The fields in which patents are held include tumor (125), spine (98), vascular (54), trauma (27), stereotaxy/image guidance (88), pain (19), peripheral nerve (2), electrical stimulation (63), and pediatrics (9); surgical instruments (59), drug delivery (17), and other (21) account for the remainder. The total amount of royalties received by neurosurgeons in 2010 is expected to be $13,223,000 (minimum: $7K, maximum: $8.261M). Despite public and legislative perceptions of widespread conflicts of interest, there are relatively few neurosurgeons who hold patents and receive significant royalties.