Dr Antony Thomas - Neurosurgeon

01/04/2026

CONGRATULATIONS ◾ Prof Binu Luke is well-known as a community worker and as Head of the Clinical Department at Tshepong hospital.

He left the hospital this week to assume his new position as the chief director, professor and head of the new Desmond Tutu School of Medicine at the NWU as of Wednesday April 1.

His role will be to provide strategic leadership, academic management, and operational direction for the School of Medicine, aligning with the university’s mission, transformation goals, and research objectives.

Klerksdorp/Tshepong Tertiary Hospital will serve as a key clinical training site. Prof Luke joined the hospital on May 8 1996, and build a career spanning three decades subsequently obtaining a Fellowship of the College of Physicians of South Africa and Fellowship of the Royal College of Physicians.

The Desmond Tutu School of Medicie is the 11th medical school in South Africa and the programme is slated for its first intake of students in 2028.

28/03/2026

28/03/2026

March is Brain Injury Awareness Month, led by the Brain Injury Association of America (BIAA) to educate the public on the causes, impact, and prevention of traumatic brain injuries (TBI). The campaign highlights the needs of survivors and families, focusing on prevention strategies like helmet use, reducing falls, and supporting rehabilitation.

Key aspects of Brain Injury Awareness Month include:

Theme and Focus: Campaigns often highlight that not all injuries are visible, focusing on the long-term, daily life impacts of TBI.

Prevention and Education: Efforts promote the use of safety equipment (helmets, seat belts) and educating athletes, coaches, and parents on concussion recognition, such as with the CDC’s "Heads Up" initiative.

Support and Advocacy: The month, often observed in March (and June in Canada), aims to raise funds, improve care, and reduce the stigma for survivors.

"Unmasking Brain Injury": A prominent project where survivors create masks to represent their experiences, with many local alliances holding displays.

Resources: Organizations like the BIAA offer webinars, blogs, and toolkits for people to share their personal stories of recovery, as noted on this page for BIAA.

https://biausa.org/public-affairs/public-awareness/brain-injury-awareness

For 2026, the campaign continues to emphasize the need for specialized care and support systems for veterans and civilians.

Suffering a traumatic brain injury - a staple of combat for U.S. troops in the last two decades - appears to increase the risk of developing brain cancer later in life, a major medical study found.

The study published in JAMA Network Open, an American Medical Association publication, looked at nearly two million post-9/11 veterans with mild, moderate/severe and penetrating traumatic brain injuries or TBIs.

The findings suggest that veterans experiencing moderate or severe TBIs were 90% more at risk for developing subsequent brain cancer than those who never suffered a TBI while those with penetrating TBIs were more than three times as likely to develop cancer. For veterans with mild cases of TBI - the most common diagnosis - their injuries were not associated with brain cancer later on.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815179

Robert Mangaliso Sobukwe Hospital

28/03/2026

24/03/2026

Dr Antony Thomas - Neurosurgeon Lenmed Private Hospitals Proudly Support Local - Kimberley

20/03/2026

10/03/2026

Glioma Grade 4 (typically Glioblastoma, IDH-wildtype) is an aggressive, fast-growing primary brain tumor. Treatment is not typically curative but aims to prolong survival and manage symptoms through a multidisciplinary approach.

Disease Treatment Standard of Care

Maximal Safe Resection: The primary goal is to remove as much of the tumor as possible without damaging crucial brain functions.

Radiotherapy & Chemotherapy: Following surgery, standard care includes radiotherapy combined with daily chemotherapy (Temozolomide), followed by further adjuvant Temozolomide.
Tumor Treating Fields (TTFields): A wearable device that delivers electric fields to slow cancer cell growth, often used after radiation.
Supportive Care: Steroids (e.g., dexamethasone) for brain swelling, anti-seizure medication, and palliative care to maintain quality of life.

Importance of Resection with 5-ALA (Gliolan®)
5-Aminolevulinic acid (5-ALA) is a fluorescent marker used to guide surgery, allowing surgeons to visualize tumor tissue that might not be visible under white light.

Increased Gross Total Resection (GTR): Studies indicate 5-ALA allows for GTR (removal of >95-98% of the tumor) in 65–79% of patients, compared to only 36–47% with standard white-light surgery.
Enhanced Precision: 5-ALA causes malignant tumor cells to glow red/pink under blue light, helping to identify infiltrative margins that extend beyond the main tumor mass.
Improved Survival & Outcomes: Resection with 5-ALA has been shown to improve progression-free survival (PFS) and overall survival (OS) by roughly 3 months, and reduces the likelihood of immediate postoperative neurological deficits.
Crucial for Recurrence: For recurrent glioblastoma, 5-ALA helps distinguish tumor tissue from radiation-induced necrosis.

5-ALA is considered a standard of care at many neurosurgical departments for high-grade gliomas.
Maximal safe resection is the single most important factor in extending survival.
The combination of 5-ALA, imaging, and functional mapping is key to achieving maximum resection, particularly near eloquent areas.

First 5 ALA guided resection was done in Kimberley at Lenmed Private Hospitals.

First patient using Olympus Orbeye Exoscope and 5ALA guided resection in Africa.

05/03/2026

Minimally Invasive Direct Lateral Interbody Fusion (MIS-DLIF/LLIF) is an advanced technique for treating degenerative spine conditions by accessing the lumbar disc space from the side (lateral) rather than through the posterior muscles (TLIF/PLIF) or front (ALIF). It is designed to minimize muscle damage, reduce blood loss, and allow for the insertion of a large, lordotic cage for deformity correction, typically at levels L1–L4.

Indications for MIS-DLIF/LLIF
Degenerative Disc Disease (DDD): With or without instability.
Lumbar Spondylolisthesis: Grade I or II degenerative slip.
Degenerative Scoliosis: Correction of coronal/sagittal balance, particularly for coronal deformity.
Adjacent Segment Disease (ASD): Revision of a previous fusion.
Foraminal Stenosis: Indirect decompression by restoring disc height.
Trauma/Infection/Tumor: In specific scenarios where traditional approaches are contraindicated.

Key Contraindications: High-grade spondylolisthesis (Grade III+), severe osteoporosis, active soft-tissue infection, and anatomical barriers (e.g., L5-S1 blocked by iliac crest).

Technique Details
Positioning: Patient is placed in the lateral decubitus position (side-lying).
Access: A small muscle-splitting incision is made in the flank. The psoas muscle is accessed, and neuromonitoring is crucial to avoid injury to the lumbar plexus (nerve network) within the muscle.
Discectomy: The disc is removed, and the annulus fibrosus is released, allowing for the placement of a large interbody cage (often 18–22 mm wide) to support the apophyseal ring of the vertebrae.
Instrumentation: Often paired with posterior percutaneous pedicle screws for maximum stability.
MIS-DLIF Variant: A specialized technique, similar to OLLIF, often performed without patient repositioning (no need to flip from side to back), making it faster.

Outcomes: MIS-DLIF/LLIF vs. Open Techniques (TLIF/PLIF)
Blood Loss: Significantly lower in MIS-DLIF/LLIF (54–112 ml) compared to open techniques (often >300 ml).
Hospital Stay: Shorter with MIS, often 0.3 to 1.7 days for 1–2 levels, compared to multiple days for open surgery.

Recovery: Faster return to normal activities due to sparing of posterior back muscles.
Deformity Correction: Superior at restoring disc height and correcting coronal balance compared to traditional TLIF.

Operative Time: MIS-DLIF (especially without repositioning) can be very fast (approx. 44–85 min for 1–2 levels), often faster than open TLIF.

Complications and Risks
Neurological Deficits: Temporary thigh numbness (meralgia paresthetica) or weakness, which is the most common complaint (10–60% of cases, though usually temporary).
Psoas Muscle Injury: Due to the transpsoas approach.
Vascular/Visceral Injury: Rare, but possible (

05/03/2026

MIS-TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion) is a, vertebral fusion technique used for degenerative disc disease, spondylolisthesis, and stenosis. It uses tubular retractors, the Wiltse approach, and percutaneous screws, resulting in significantly less blood loss, reduced postoperative pain, and shorter hospital stays compared to traditional open surgery.

Indications
MIS-TLIF is generally indicated for conditions requiring lumbar decompression and fusion where minimizing soft tissue injury is preferred:

Degenerative Disc Disease (DDD): With associated instability.
Low-Grade Spondylolisthesis: Grade 1 and 2.
Lumbar Spinal Stenosis: Specifically for unilateral approach/bilateral decompression (over-the-top).
Recurrent Disc Herniation: Where scarring makes open revision difficult.
Adjacent Segment Disease (ASD): To avoid further disrupting previously operated muscles.

Surgical Technique
The technique focuses on reducing damage to the back muscles and spine:

Approach: A, paramedian approach (Wiltse plane) separates the multifidus and longissimus muscles rather than stripping them from the bone.
Decompression: Tubular retractors are used to perform a "midline crossing" decompression, where the disc space is accessed unilaterally but allows for bilateral nerve decompression.
Instrumentation: Percutaneous pedicle screws are placed under fluoroscopic guidance.

Fusion: An interbody cage is inserted into the disc space.
Navigation: Advanced techniques often incorporate navigation for more precise placement of instrumentation

While offering better, faster recovery, MIS-TLIF has a steeper learning curve for surgeons and involves higher, exposure to, radiation (fluoroscopy) during the procedure

https://surgicalneurologyint.com/surgicalint-articles/minimally-invasive-versus-open-transforaminal-lumbar-interbody-fusion/

https://pmc.ncbi.nlm.nih.gov/articles/PMC9243253/

https://www.sciencedirect.com/science/article/abs/pii/S0976566218301516