Dr Antony Thomas - Neurosurgeon

Dr Antony Thomas - Neurosurgeon Neurosurgeon

Cancer pain is one of the hardest challenges we face in practice.Opioids remain the backbone of treatment, but they are ...
14/10/2025

Cancer pain is one of the hardest challenges we face in practice.

Opioids remain the backbone of treatment, but they are not always effective. For patients with abdominal malignancies, pain can be severe, unrelenting, and resistant to escalating doses. Side effects compound the burden.

A study in Cureus (Paul & Borkar, 2022) reviewed the role of fluoroscopy-guided splanchnic nerve blocks for cancer-associated abdominal pain. This approach is particularly valuable when tumours distort celiac plexus anatomy, making traditional celiac plexus blocks less effective.

Key takeaways:

• Splanchnic nerve blocks can provide meaningful pain relief in patients with refractory cancer pain

Neurolysis or radiofrequency ablation reduces opioid dependence and associated side effects

Improved functional status and quality of life were consistently observed

• These blocks can be technically easier than celiac plexus blocks in patients with altered anatomy

we view these interventions as critical components of advanced cancer pain management. They are not curative, but they can restore dignity, comfort, and daily function where systemic therapies fall short.

Reference: Paul A, Borkar A. Fluoroscopy-Guided Splanchnic Nerve Block for Cancer-Associated Pain. Cureus. 2022.

In your experience, are advanced blocks like splanchnic neurolysis underutilised in cancer pain management? What barriers do you see to broader adoption?

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https://pubmed.ncbi.nlm.nih.gov/40988238/

Awake Transforaminal Endoscopic Lumbar Discectomy (TELD) – L5–S1 Disc ProlapseOpen microdiscectomy has long been the gol...
20/09/2025

Awake Transforaminal Endoscopic Lumbar Discectomy (TELD) – L5–S1 Disc Prolapse

Open microdiscectomy has long been the gold standard for treating radiculopathy caused by lumbar disc herniation. Today, however, Transforaminal Endoscopic Lumbar Discectomy (TELD) offers a highly effective, minimally invasive alternative.
With ongoing technical refinements, TELD now delivers clinical outcomes comparable to traditional open surgery while allowing faster recovery and less postoperative discomfort.

Our recent case highlights these benefits:

Pre- and post-operative MRI confirmed successful removal of the L5–S1 disc herniation.

The procedure was performed under awake endoscopic guidance, avoiding general anesthesia.

The patient is already symptom-free and doing very well.

Minimally invasive spine surgery continues to expand the possibilities for safe and reliable care.

🔗 Learn more about TELD: International Journal of Spine Surgery

https://www.ijssurgery.com/content/15/suppl_3/s38

29/08/2025
Stryker NavigationUsed for First time in South Africa For posterior thoracic spine instrumentation and fusion Correction...
29/08/2025

Stryker Navigation

Used for First time in South Africa

For posterior thoracic spine instrumentation and fusion
Correction of Kyphosis for acute spine fracture patients in Lenmed Private Hospitals Kimberley.

1st case.
Severe kyphosis, with anterior wedge deformities of T6/7 vertebral bodies, Impression of T6 comminuted vertebral body fracture, and left upifacet dislocation.

2nd case.
T4 and T5 compression, left T3-T8 and
right T4-T5 transverse process and bilateral T4 and right T5 lamina fractures. Hyperintense signal changes of T4 and T5 present on STIR and T2W. In keeping with acute fracture/injury. Excessive thoracic kyphosis. Hyperintense signal demonstrated within the central aspect of the cord, affect segment involved T4-T5.

It was a learning Curve for everyone and was a team effort.

Recurrent lumbar disc herniation (RLDH) remains one of the most frustrating challenges in spine surgery. Despite a techn...
19/08/2025

Recurrent lumbar disc herniation (RLDH) remains one of the most frustrating challenges in spine surgery. Despite a technically successful primary discectomy, up to 18% of patients experience symptomatic recurrence. When they do, we're left with a decision that has sparked decades of debate: Should we repeat the discectomy, or should we fuse?

Let's take a look at what the data says: Meta-analyses and large database studies offer mixed insights.

Fusion may reduce recurrence and segmental instability... Lei et al. (World Neurosurg, 2023): In a meta-analysis of 11 studies, fusion reduced neurological deficit, segmental instability, and re-recurrence vs repeat discectomy, although fusion was associated with longer operative time, greater blood loss, and longer hospital stay.

Mucuoglu et al. (Neurosurg Rev, 2025): In a retrospective review of 276 patients, patients undergoing discectomy with fusion (PLF or PLIF) had significantly better postoperative pain scores and recovery rates compared to repeat discectomy alone (77% vs 71.8%).

But repeat discectomy remains effective and far less invasive. Guan et al. (J Neurosurg Spine, 2017): Using N2QOD data, both fusion and repeat discectomy achieved similar

outcomes at 3 and 12 months. However, fusion patients had 3x longer operative times, greater costs, and longer lengths of stay - with no improvement in QALYs.

Tanavalee et al. (J Clin Neurosci, 2019): Their meta-analysis showed no statistically significant difference in reoperation rates between fusion and discectomy. Discectomy had shorter OR time and hospital stay.

Clinical takeaways:

Fusion may be better for patients with significant back pain, segmental instability, or recurrence after multiple discectomies.

Repeat discectomy is ideal for younger patients with minimal back pain, lower surgical risk tolerance, or concerns about adjacent segment disease.

No consensus exists, and even meta-analyses draw different conclusions based on definitions of recurrence and radiographic instability.

17/08/2025
In Memoriam: Professor Mahmut Gazi Yaşargil (1925–2025)University of Zurich Neurosurgery DepartmentMahmut Gazi Yaşargil,...
06/08/2025

In Memoriam: Professor Mahmut Gazi Yaşargil (1925–2025)

University of Zurich Neurosurgery Department

Mahmut Gazi Yaşargil, born July 6, 1925 in Lice, Diyarbakır, and deceased June 10, 2025 in Stäfa, Canton Zurich, Switzerland, was one of the towering figures in modern neurosurgery. From 1953 to 1993, he served as resident, senior surgeon, then full Professor and Chair of the Department of Neurosurgery at the University Hospital Zurich, profoundly shaping the department into a global center for microsurgical innovation .

Key Contributions & Innovations

Pioneer of Microneurosurgery

Yaşargil is globally credited with founding microneurosurgery. His early work in Zurich introduced the routine use of operating microscopes in cranial surgery, redefining the discipline’s possibilities .

Surgical Microscope & First EC‑IC Bypass

After specialized training in microvascular surgery at the University of Vermont (1965–66), he returned to Zurich to perform the first human superficial temporal–middle cerebral artery (STA‑MCA) bypass on January 18, 1967—ushering in a new vascular neurosurgery era .

Development of Microsurgical Instruments

He pioneered a suite of microsurgical tools—adjustable retractors, aneurysm clips, micro‑instrument tables, ergonomic instruments, and more—that remain foundational in neurosurgical operating rooms worldwide .

Global Neurosurgical Training & Impact

Between 1973 and 1992, during his tenure as Department Chair at Zurich, Yaşargil personally oversaw and trained over 3,000 neurosurgeons from six continents in microsurgical techniques—many of whom went on to lead neurosurgery programs globally .

His magnum opus, the six‑volume “Microneurosurgery” series (1984–1996, published by Georg Thieme), remains the definitive reference for cerebrovascular microsurgery .

University of Zurich — Legacy & Recognition

In 1999, the Congress of Neurological Surgeons named him “Neurosurgery’s Man of the Century (1950–1999)”, acknowledging his transformative influence .

Since 2014, the University of Zurich Faculty of Medicine has hosted its annual “Yaşargil Conferences” in honor of his enduring contributions .

In July 2025, just after his 100th birthday, Zurich played host to the Yaşargil 100th Anniversary Symposium—an international gathering honoring his life and legacy—organized by the University Hospital Zurich in collaboration with WANS .

Milestones at the University of Zurich

Stage Years Highlights

Residency & Senior Surgery under Prof. Krayenbühl 1953–1965 Cerebral angiography, stereotactic surgery for movement disorders, early neurosurgical publications
Microvascular Fellowship in USA and return 1965–1967 Microsurgical training in Vermont and first human EC‑IC bypass in Zurich
Full Professor & Department Chair 1973–1992 Oversaw ~7,500 intracranial operations and global surgeon training
Founding Microneurosurgery Laboratory 1968–1993 Trained more than 3,000 neurosurgeons from across the world

Legacy—Precision, Passion, Teaching

Professor Yaşargil’s legacy at the University of Zurich is felt in every operating microscope, every vascular anastomosis performed, and every surgeon trained under his methods. His instruments, techniques, and scientific writings continue to guide present-day neurosurgery. The annual Yaşargil Lecture and Conference series ensure that his philosophy of precision and relentless innovation continues to inspire.

It was such a highlight in my career to meet, talk and learn from the Father of Modern Neurosurgery.

Nerve Blocks in the Treatment of Headache.* Greater occipital nerve (GON) block has shown benefit in migraine, cluster h...
18/07/2025

Nerve Blocks in the Treatment of Headache.

* Greater occipital nerve (GON) block has shown benefit in migraine, cluster headache, cervicogenic headache, and post-concussion headache

Response rates are especially strong in patients with occipital tenderness

GON block may reduce allodynia and central sensitisation, even when scalp anaesthesia is partial

* Supraorbital and supratrochlear blocks can be useful for frontal headache and post-traumatic neuralgia

* Sphenopalatine ganglion blocks, especially via intranasal application, have been effective in some cluster headache presentations

Despite the lack of large placebo-controlled trials, multiple smaller studies and clinical reports suggest that nerve blocks may help interrupt the cycle of pain in chronic or refractory headache cases - especially when sensitisation plays a role.

Reference: Levin M. (2010). Nerve Blocks in the Treatment of Headache. Neurotherapeutics; 7(2):197-203.

Link: https://ow.ly/VFSB50WoJP1

09/07/2025
27/06/2025

Dr Faizel Kimmie is General Surgeon who works at Lenmed Royal Hospital and Heart Centre Kimberley.

✅ Colonoscopies and gastroscopies
✅ Colon and breast surgery
✅ Hereditary colon cancer syndromes
✅ Hernia repair, circumcisions and more

21/06/2025

Dr Irshaad Abdoola performs corrective jaw surgery at state of the art private hospitals in Kimberley and Potchefstroom.

The procedure is performed under general anaesthetic, and involves moving your jaw/jaws into the correct position.

Please contact our rooms on 053 0450532 to schedule a consultation with Dr.
Kimberley| Potchefstroom| Kathu

Address

ROOM G04 Lenmed Royal Hospital And Heart Centre , 6 Welgevonden Street, Royldene
Kimberley
8301

Opening Hours

Monday 09:00 - 17:00
Tuesday 09:00 - 17:00
Wednesday 09:00 - 17:00
Thursday 09:00 - 17:00
Friday 09:00 - 17:00

Telephone

+27648215246

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