Welcome to the second edition of the year. This edition hosts the abstracts of the April meeting of the Society of British Neurological Surgeons – on this occasion hosted by the Newcastle Unit. These you can find as usual at the start of the edition.
At the time of writing no new health related neurosurgical political news to impart or comment upon in particular – must be a relief to all readers, though perhaps things will have changed by the time of publication!
The edition itself has a number of themes that I felt might be discussion points to some degree for the meeting. There are within the abstracts and posters also some mention of all these subjects – and in fact some from the most recent edition of the journal – eg the Montgomery ruling. I rather hope that the Montgomery ruling has as many implications for non-surgeons as it does for surgeons – surely no longer can a physician proceed to treat conditions medically without informing the patient at the time of diagnosis of the existence of a surgical therapy – examples that occur to myself are those of trigeminal neuralgia, hemifacial spasm, epilepsy surgery, deep brain stimulation for Parkinson’s disease (especially following the more recent studies of early stimulation – meaning earlier in the progression of the condition). Naturally the risks of such therapies – must be properly and transparently explained to patients – but the choice of risk and potential benefit is a matter for the patient and not the physician/surgeon. It is of course the case that the true efficacies and side effect profiles of medical therapies - or indeed any non-invasive therapy – need to be fully explained, and some health economic studies would suggest that particularly the latter are frequently underestimated, as judged by the number of health care contacts. Perhaps one outcome from “Montgomery” is a requirement for patients to be managed in pluripotential centres – that is it is important to be able to offer a comprehensive range of treatments and to be experienced in them all.
The other topics include establishing the correct level for surgery including an argument relating this item to the definition of “never” events. Perhaps with issues around junior doctor workloads are items concerning neurosurgical referrals, and handling of the same; and finally a theme concerning head injuries – including articles on the question of craniectomy and its sequel – the cranioplasty; prediction of outcomes and required resources. Again I notice abstracts and posters from the meeting concerning all of these areas.
Mr Jason Brice (24/1/1927–1/10/2015)
After training in London, with a spell in Chicago, in 1963 Jason Brice was appointed consultant neurosurgeon in Southampton, at the urging of Mr (later Sir) Wylie McKissock, of Atkinson Morley’s Hospital, to establish a neurosurgical unit. The local neurologists, Stanley Graveson and Peter Robinson, who had provided peripatetic neurology services in Wessex since 1950, had demonstrated the need locally. He oversaw the building, staffing and commissioning of a modern neurosciences department, adapted to his specifications, and opening under his direction in 1965. John Garfield joined him as senior registrar initially, becoming his career-long consultant colleague from 1968. High quality training proved the secret to staffing the medical and nursing teams, together with excellent paramedical services. He saw the unit thrive, forming an academic department and expanding over the subsequent decades via the five consultant neurosurgeons on his retirement in 1992, to the current complement of 11, after various building extensions that commenced in the 1990s to accommodate the ever-increasing workload.
Jason was active regionally (as Director of Medical Manpower) and nationally, having chaired the Court of Examiners of the Royal College of Surgeons, and acted as external examiner for the Royal College of Physicians and Surgeons of Glasgow. He also served as President of the Section of Neurology (now Clinical Neurosciences) of the Royal Society of Medicine, as President of the SBNS, and on the Advisory Panel to the Chief Medical Officer, Sir Donald Acheson. Locally, he taught neuro-anatomy to generations of Southampton medical students, inspiring a number of current consultants to become neurosurgeons.
His research, mainly clinically based, included functional neurosurgery, leading to the ground-breaking report in The Lancet in 1980 with Lindsay McLellan of the world’s first two cases of deep brain stimulation using permanent implanted electrodes, done for intention tremor in multiple sclerosis, and of a double-blind trial of cerebellar stimulation for epilepsy four years later.
After retiring in 1992, with ill-health a factor, he continued to show a lively interest in postgraduate training locally, and in the research laboratories, where despite very limited vision he was to be found attending lectures as recently as 2015. He attended the Gala Dinner of the September 2013 SBNS meeting in Colchester (hosted by the Romford unit) to receive the Society’s Medal, of which he was inordinately proud. Having made an indelible mark on neurosurgery, Jason passed away peacefully at home on 1 October 2015.