Neurosurgery

Introduction

The regional neurosurgical unit for South Trent , previously based in Derbyshire Royal Infirmary, moved to the Queen's Medical Centre in 1985 and is now one of the busiest neurosurgical departments in the country. All major neurosurgical subspecialities including Paediatric neurosurgery and Functional neurosurgery are provided here by a team of 9 consultants to a catchment population of around 3 million.

Clinical work

Whilst all operations ( around 1700 / year, 280 of them in children) are performed at QMC, staff from the unit here also carry out weekly Outpatient clinics in Leicester General Hospital and Derbyshire Royal Infirmary. Neurosurgery is a specialty with a very high proportion of emergency and urgent work and adult referrals come from hospitals throughout Nottinghamshire, Derbyshire, Leicestershire and parts of Lincolnshire (right) . Our paediatric catchment area is wider and includes Lincoln and Stoke.

Profile

The neurosurgical unit in Nottingham has a high profile in the wider neurosurgical community. It has a strong reputation for training and for innovation. Staff here act as examiners for the Intercollegiate FRCS Examination in Neurosurgery and this is one of a small number of units in the country to regularly host this examination. Neuro- endoscopic techniques and expertise developed here have been disseminated around the country through regular practical courses held at the Royal College of Surgeons. Iain Robertson sits on the Royal Colleges' SAC ( Specialist Advisory Committee) for Neurosurgery. Barrie White is a past Vice-President of the Society of British Neurological Surgeons and the last meeting of this society was hosted here in September 2008.

Research

Nottingham has consistently been a significant contributor to key multicentre neurosurgical studies. We were the largest sole contributor to the International Sub Arachnoid Aneurysm Trial (ISAT) which revolutionised the management of ruptured cerebral aneurysms, and contributed patients as well as Terry Hope's expertise to the steering committee of the STICH trial looking at the role of surgery in intracerebral haemorrhage.

In neuro-oncology we have participated in the evaluation of new therapies for brain tumours including Gliadel implantable chemotherapy and a novel Gene Therapy study for gliomas. Paul Byrne has been leading a project to develop a neurosurgical robot , funded by the Department of Trade and Industry. Nottingham is part of a Functional Imaging Network which is steadily accruing and sharing data which allows detailed characterisation of brain tumours noninvasively.

In functional neurosurgery, patients are now being enrolled here in the national trial of surgery for Parkinson's disease. Michael Vloeberghs is internationally recognised as having one of the largest series in the world of children with spastic cerebral palsy treated with continuous intrathecal baclofen. Children are referred here for this from as far afield as Scotland and Wales and a national randomised study of intrathecal baclofen treatment is now under way.

Challenges

From the original three consultants who transferred in 1985 this unit has steadily evolved to allow it to continue to provide the best possible neurosurgical care to the people of the East Midlands. Physical constraints on ward bed and ITU bed numbers as well as numbers of personnel have long been recognised and have been addressed to some extent in the last few years. A third neurosurgical operating theatre was opened in 2005 so that emergency work no longer has to displace planned cases from the other theatres. These changes are part of a significant 5 year development programme which commenced in 2004 and has been funded at a regional level to ensure that neurosurgical provision now meets nationally agreed standards. Recent boundary changes to the East Midlands Strategic Health Authority bring the populations of Kettering and Northampton into our region and this will necessitate appropriate further investment.