Dr Antony Thomas - Neurosurgeon

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

06/08/2025

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.

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

25/05/2025

Trigeminal Neuralgia: The "Electric Shocks on the Face!"

Trigeminal Neuralgia (TN) is one of the most common facial pain syndromes encountered in neurology practice.

It's characterized by sudden, severe, electric shock-like, stabbing, and recurrent pain-usually unilateral-in the distribution of the trigeminal nerve (CN V).

Why does it happen?

In ~90% of cases, a vascular loop (most often an artery) compresses the root entry zone (REZ) of CN V at the pons-leading to focal demyelination and ectopic impulse generation

1. Neurovascular Compression (Most common)

Typically involves the superior cerebellar artery compressing the trigeminal nerve root at the root entry zone (REZ)

Leads to focal demyelination and ectopic neural firing

2. Multiple Sclerosis (MS)

Seen in younger patients

Caused by demyelinating plaques in the pons involving the trigeminal nerve root

Often bilateral or atypical presentation

3. Tumors

Cerebellopontine angle tumors (e.g., vestibular schwannoma, meningioma)

Direct compression or distortion of the nerve

May have associated symptoms like hearing loss, ataxia

4. Postherpetic Neuralgia

Following herpes zoster infection involvingPostherpetic Neuralgia

Following herpes zoster infection involving trigeminal dermatomes (especially V1)

Pain may be burning or dysesthetic, not classic paroxysmal TN

5.Secondary (Symptomatic) TN

Due to systemic or local diseases, e.g.,

Sarcoidosis

Sjogren's syndrome

Brainstem infarcts or AVMs

Clinical Features:

Paroxysmal pain lasting seconds to 2 minutes

Described as sharp/shooting

Precipitated by mild triggers like talking, chewing, or even touching the face (allodynia)

Most commonly affects V2 and V3 branchesImaging:

✓ 3D Fiesta MRI is preferred to detect neurovascular conflict

Don't forget to test HLA-B*1502 before initiating carbamazepine
(risk of Stevens-Johnson syndrome, especially in Asians)

Medical Management:

Carbamazepine is the first-line, start with 100-200 mg BID

Titrate gradually up to 600-1200 mg/day

Oxcarbazepine /Eslicarbemazepine - Better tolerated alternative

Lamotrigine - Up to 400 mg/day, also useful

Phenytoin - IV option in refractory or acute settings 3-5 mg/kg

Baclofen - GABA-B agonist, effective adjunct 30-60 mg /day

Gabapentin - Adjunctive option 900-1800 mg/ day

8% Intranasal Lignocaine - Especially for V2 pain; may relieve pain for 30 mins to 24 hrs8% Intranasal Lignocaine - Especially for V2 pain; may relieve pain for 30 mins to 24 hrs

Interventional Therapies for Refractory TN:

1 Microvascular Decompression (MVD) - Most definitive, long-term relief

2 Radiofrequency Rhizotomy - Selective ablation at the Gasserian ganglion

3 Glycerol or Balloon Gangliolysis - Chemical/ mechanical ganglion ablation

4 Peripheral Neurectomy - For pain limited to peripheral branches

5 Nerve/Neurolytic Blocks - Temporary but effective

15/05/2025

High-Grade Traumatic C7-T1 Spondylolisthesis Without Neurological Deficit

High-grade traumatic spondylolisthesis at the cervicothoracic junction (CTJ) is rare and typically associated with severe instability and high risk for spinal cord injury. We present a case of traumatic C7-T1 spondylolisthesis with intact neurological function managed successfully using combined anterior-posterior instrumentation.

Case Description:
A neurologically intact patient presented with a high-grade C7-T1 traumatic spondylolisthesis following trauma. Preoperative imaging (CT and MRI) revealed anterior translation of C7 over T1, with disruption of both anterior and posterior spinal elements. Despite the severity, the patient exhibited no neurological deficits, likely due to spontaneous posterior decompression following posterior element fractures \[1,2].

Given the instability, closed reduction was carefully attempted but definitive management required a staged surgical approach. Anterior cervical discectomy and fusion (ACDF) was performed first to address potential disc herniation and decompress the spinal cord, minimizing the risk of iatrogenic neurological injury during patient repositioning \[3]. This was followed by posterior instrumentation and fusion for additional stabilization.

Outcome:
Postoperative radiographs confirmed successful realignment and stabilization. The patient remained neurologically intact throughout the perioperative period.

Conclusion:
High-grade traumatic C7-T1 spondylolisthesis without neurological impairment is exceedingly rare. Careful evaluation for posterior element fractures is crucial, as they may allow spontaneous canal decompression. In such cases, combined anterior-posterior fixation is recommended for durable stabilization. The anterior approach should be prioritized in the presence of disc herniation to prevent secondary spinal cord injury.

References:

1. Bono CM, et al. *Spine (Phila Pa 1976)*. 2006;31(11 Suppl)\:S65–S70.
2. Anderson PA, et al. *Neurosurgery*. 2010;66(3 Suppl)\:S68–S73.
3. Kandziora F, et al. *Spine J*. 2001;1(6):471–482.

10/05/2025

https://www.scientificamerican.com/article/accidental-genius/

Acquired savant syndrome

is a rare phenomenon where an individual develops exceptional skills or abilities in areas like music, art, or mathematics after a brain injury or other neurological event, often following damage to the left hemisphere.
These new skills are often unexpected and can be quite impressive.

Key aspects of acquired savant syndrome:

Sudden emergence:
The new abilities typically appear after a brain injury or other neurological event.
Left hemisphere damage:
Many cases involve damage to the left hemisphere of the brain.

Specific skills:
These skills can include extraordinary musical talent, artistic brilliance, mathematical mastery, or enhanced memory.
Unprecedented ability:
The individual may not have had any prior experience or aptitude in the newly acquired skill before the injury or event.
Obsessive interest:
Individuals with acquired savant syndrome often become intensely interested in the new ability and may compulsively practice or display it.

Examples:
Derek Amato, who developed a love for playing the piano after a concussion, and Jason Padgett, an artist who developed a unique ability to see patterns, are examples of acquired savant syndrome.
Examples of skills associated with acquired savant syndrome:
Music:
Playing musical instruments, composing music, or memorizing complex melodies.
Art:
Creating highly detailed or abstract art, even if the individual had no prior artistic experience.
Mathematics:
Calculating complex numbers, performing mental arithmetic, or recognizing mathematical patterns.
Memory:
Photographic memory, the ability to recall vast amounts of information, or the ability to instantly calculate dates.
Language:
Developing an ability to speak or understand multiple languages, or a heightened awareness of language patterns.
Mechanical or spatial skills:
Accurately measuring distances, building complex structures, or understanding spatial relationships.
Acquired savant syndrome is a fascinating area of study that raises questions about the brain's plasticity and the potential for hidden abilities to be unlocked after a brain injury.

A blow to the head can sometimes unmask hidden artistic or intellectual gifts. Might we all have hidden capacities that could be unleashed without brain injury?