| James (0:12) | You are listening to another podcast from the Health Check Research Centre in brain and spinal injury, where I'm chatting to all sorts of interesting folk about brains, and particularly brain injury. And I thought it'd be really interesting to coincide with the Society of British Neurological Surgeons' 100th anniversary to talk to somebody who's explored the history of neurosurgery in the UK. So I'm joined by Jonathan Pollock. Jonathan, thanks ever so much for coming on the podcast. | ||||
| Jonathan (00:33) | Thanks, James. Nice to be able to talk to you. | ||||
| James (00:35) | So you are a surgeon yourself practicing now, that's right? | ||||
| Jonathan (00:38) | That's right, yes. So I work in the Essex Neurosciences Centre based in Romford, one of the seven London units. I've been there a long time now; I was appointed in 2002. So I go back a little bit myself. | ||||
| James (00:52) | So you've got quite a lot of history yourself! And I'm imagining that these changes that have happened in the last 20 years, you're kind of aware of. Maybe we'll come to that. I want to throw us right back to the beginning. When did something that we'd recognize today as neurosurgery start in the UK? | ||||
| Jonathan (01:10) | It is actually quite difficult to sort of put your finger on a starting point, because one thing we've treated for a long, long time, you know, for a few hundred years, is injuries to the brain. So there's no question that the first sort of efforts at treating the head were to do with treating injury. And that usually meant people treating depressed fractures in the skull, for example, because of course before the modern era, you know, there were no real concept of safety. And so brain injury and head injury was a very common form of trauma. And so the earliest people who would have treated that might have been, for example, elevating skull fractures or letting out superficial blood from the surface of the brain underneath the skull. Usually something you could actually see. I know that sounds rather obvious, but of course one thing that is fairly recent in neurosurgery is imaging, is actually looking inside the head. And that's really only—that's very much a feature of the 20th century. Before that, you know, there was no imaging that would let you see inside the head. | ||||
| James (02:22) | Yeah, so you've just got patients, there are obvious fractures, you can see the bone is broken, it's pushed in and touching the brain, so obviously you want to check that out, right, and see what you can under there and get rid of the mess. | ||||
| Jonathan (02:35) | Yeah, that's right. And I mean that for, well, pretty much thousands of years was pretty much the limit of what people did. There was one reason why they were limited to that—it wasn't just that they couldn't see inside, it was also that it was known that if you did expose the brain, it was a very dangerous thing to do because of infection. So if you open the covering layer, the tough dura, which is the stuff just underneath the skull, in the years before clean surgery, in the years before antibiotics, that often gave rise to infection inside, so you'd run into problems with abscesses and patients often died of sepsis. So that really put people off going inside the head, and it kept them out for a long, long time, pretty much until end of the 19th century, really. | ||||
| James (03:26) | Yeah, I was going to say it's probably sort of second half of the 19th century that we start to understand germ theory of disease and understand what infection is. So that's—that's quite recent, really, isn't it? | ||||
| Jonathan (03:36) | Absolutely. Yeah. And the—the big shift, as—I mean, some people will have heard of this guy in terms of all surgery, but Joseph Lister was the one who worked out that if you cut the—effectively if you just cut the number of bugs on the surface by using an antiseptic, then you made surgery safer, and that applied all over the body, but it certainly applied to the head. So once people started to operate in a—the way he did it was you had a cloud of carbolic acid and they did their surgery in that—and that then meant it was at least safe to start looking inside cavities which hadn't previously been explored. And that applied to the brain as well, so that's 1870s, 1880s. So that was one aspect that allowed people to start exploring. And the other was that by the work of a very clever bunch of neurologists, it was worked out that there were specific bits of the brain that did different things. And once you started to understand that, then of course you could deduce where there was a problem. So, for example, if the speech disappeared, you knew that it was a frontal lobe abnormality, and if you ended up with a weak leg, you knew it was a problem on the opposite side of the brain near the top of the skull. So these—these kind of what—what was known as cerebral localization, this ability to—to make a—a judgment about where the problem was without having any imaging, sure, but they had—they could—they could deduce that from clinical assessment. That then allowed them to target where they were going. So it was a combination of those two things in the late 19th century: being cleaner and having a lower infection rate, and also having some concept of how to target what you were doing. | ||||
| James (05:25) | And I guess also tools, instruments—you need to get through that really hard thing on the top of your head... | ||||
| Jonathan (05:33) | Yes. | ||||
| James (05:33) | ...and safely without damaging the sensitive membranes and the brain underneath the skull. | ||||
| Jonathan (05:37) | Yeah. I mean, I think I might say in theory, but if you look at some of the early instruments, they were pretty crude, but those actually didn't change much. There was a standard thing called a trephine, which was shaped a bit like a corkscrew, which drilled a little circular hole in the skull. And that tool was around for a long, long time, certainly right up until turn of the 20th century, the trephine was a standard hand tool for drilling a hole in the head, and it had been in use for at least 200, 300 years. So those—those basic instruments were fairly—fairly long-standing. And then another feature of the 20th century was that, you're right, they—they started to produce instruments which were safer, so things that would allow you into the head without damaging the underlying brain. That—all those kind of tools, better drills and better saws came in sort of in the—more or less in the 20th century, and then you could add in safer surgery to, you know, the actual concept of doing it at all and put the two together, yeah. | ||||
| James (06:48) | I just said that it's the centenary of the SBNS this year, so that means that 100 years ago, there were enough neurosurgeons to come together and form a society. So I'm guessing that period then from the end of the 19th century and through the first decades of the 20th century, we start to see neurosurgery as a kind of academic, clinical profession? | ||||
| Jonathan (07:11) | Yes, although it was slow. So what happened was that the—the surgeons that started off in the 1880s generally did neurosurgery as part of their whole surgical practice. Apart from anything else, there was so little of it that you wouldn't have earned a living if you had just concentrated on that. So they were what we would now call general surgeons; in other words, they had an interest in all aspects of the body. So they would have done amputations. There weren't—bear in mind the shopping list of operations available then was pretty short—but they would have done amputations, they would occasionally have treated abscesses elsewhere in the body, they'd have treated—they certainly would have trephined holes in the head if they had to. But surgery was never—in that era, it was still a rare thing to do. But as you—as you imply, what happened over a matter of decades is they started to become more focused. And the key thing about the 1920s is that was definitely the time where they did start to become sub-specialized. So there was enough progress at that point for at least some surgeons to give, if not all of their time, majority of their time to neurosurgery. There's still, frankly, small numbers. I mean, before the war, we only had about half a dozen of these people, but that still, you know, was a quite a marked change. And that—that shift actually happened, although the UK can certainly claim to have got the Victorian stuff going in the 1880s, the early 20th century shift was largely in the States. There was a guy called Cushing, who was a famous American surgeon, who kind of refined the whole thing and invested a lot of time and effort in getting a research team together to improve various aspects of it. So it was certainly—certainly improving the infection rate, he was improving the sort of care with which the head was opened and the brain was handled, and then suddenly it started to become safer. So the—the death rate from surgery was cut quite dramatically with some of Cushing's innovations. And a whole bunch of the British surgeons went over and learned with him and then brought those newer techniques back. So that—that was what was going on in the '20s that shifted things. And it's funny you said, you know, there's enough people to put a society together, but there still weren't very many. That first meeting, they had 15 people there, and three of those were not surgeons. In fact, I think four of them were not surgeons, so there were only about 10 who actually worked with their hands. Still not many, but enough for them to start to think we need to get together and start to refine this. | ||||
| James (09:59) | Yeah, I guess to see the benefits of sharing skills and experience within that group, which kind of continues in the society today. | ||||
| Jonathan (10:07) | Yes, that's true, James. | ||||
| James (10:09) | We have this challenge, don't we, when we look back at the history of science in general and medicine, that it's quite Western. Do we know what was happening in other parts of the world? Is this a case where, you know, in Persia they were doing it 1,000 years before us, and in China they were—they were three steps ahead? | ||||
| Jonathan (10:27) | That's a very good point. And actually, the—oddly enough, the answer to some of that is we actually don't know, because it's pretty clear that some of the ancient civilizations were probably doing some of this, and then it died out. So if you look at things like ancient Egypt, Rome, Mesopotamia, people have unearthed some brilliant looking surgical instruments for the head from those civilizations. Particularly the Romans, if you look at the bunch of instruments that were unearthed over time belonging to Roman surgeons, clearly the implication there is that some of the ancient civilizations were doing some of this, at least to a certain extent in a slightly more aggressive way, before it popped up in the West. But there's no doubt that because of the man in the USA, Harvey Cushing, was so dominant in this field, he actually more or less seeded neurosurgery almost worldwide. So you're right, there were pockets of activity elsewhere, but what we recognize as modern neurosurgery was pretty much put together by him. His style of bringing together an academic department, bringing research in, and refining the technical side of it was a—pretty much the sort of focus for the rest of the world, and gradually it spread out all over the place. So if you look at most countries, they date the start of their modern neurosurgery from the first time somebody went to work with Harvey Cushing, and then obviously within a generation or two, everybody was then training their own surgeons, so those habits were more widely disseminated. | ||||
| James (12:13) | Yeah, okay. So I'm trying to think roughly chronologically. We've got the '20s, this is a big kind of time and stuff's happening. Then of course, we have a war, World War II. And inevitably conflict leads to huge developments in medicine because there are so many more casualties all of a sudden. Did we see that happening in neurosurgery as we did in other areas of medicine? | ||||
| Jonathan (12:35) | Yes, there's a few things that happened around the time of the war. I mean, the—the first thing that's worth mentioning is in the decade or so before the war, some of the imaging got better. So in the very early years of the 20th century, it was still difficult to find things in the head. You thought a patient had a tumor, you examined them, there were signs they might have one, but you couldn't be sure. In those decades before the war, imaging picked up, so that's quite a key one, although it wasn't actually in the war itself, but it was around that time. But the wartime in the UK, a couple of things happened. Firstly, we suddenly had a lot more facility for neurosurgery. So a lot of emergency hospitals were opened, full of beds, partly because I think it was anticipated that the air raid casualties would be at much higher numbers than they eventually were, because if you remember, we won the Battle of Britain. So where it looked as if we were going to be literally carpet bombed, that didn't quite happen. Of course we had very serious Blitz casualties and V-rocket casualties, but the numbers were never quite what were feared. And therefore, there was a bit of spare capacity, and the neurosurgeons, I can tell you, made very good use of that. And they started doing more planned surgery during the war. So on one hand, space and capacity at home improved. And on the other hand, they sent young surgeons off around the world. There was a surgeon, a senior surgeon in Oxford called Cairns, who put together mobile neurosurgical units. These were quite well-crafted little groups of 12 people with a couple of vans packed with surgical kit, and they would follow the lines of—of battle, and they would collect the head injuries in each theater of war and just concentrate on those. So you can imagine how these young guys suddenly developed skills they would never have otherwise—I mean, some of them were for over a period of months treating 1,000 or 2,000 cases, and this was suddenly a massive amount of experience. So the combination of capacity at home and experience gained abroad meant that in their hands, neurosurgery was suddenly something they were doing an awful lot of. Admittedly, it was a bit restrictive because it was pretty much bullet wounds, shrapnel wounds, mine wounds to the head; it wasn't, you know, there was no tumor surgery going on in these units, but they still gained confidence in what they were doing. And you can imagine that when those surgeons came home, they had the skills, they had the confidence to lead units, and they had, in many locations, the basis of a unit because the beds had been opened, hospital capacity had been increased, and so that generation of wartime surgeons sort of led how things—led the units as they developed after the war. Yeah. The neurosurgeons were big players in the development of penicillin, use of penicillin, because brain being very vulnerable to infection, they were extremely keen to see if it made a difference, and they started trialing penicillin. And first of those papers appeared from Italy around the Battle of Monte Cassino, and they figured out that as soon as they started using penicillin on these—on these wounded soldiers, the rate of infection was cut significantly. So it was obvious that that was going to be another big factor in improving neurosurgery care. | ||||
| James (16:21) | Yeah, yeah, because I guess for a long time, you'll have people dying, but they may not necessarily have been dying because of the surgery or because of what the surgery was for, but because they've developed infections during the process. And then of course after the war, we get the NHS... | ||||
| Jonathan (16:38) | Yes. | ||||
| James (16:38) | ...which must radically change the kinds of people you're going to be treated. I'm guessing that before that, if you had a tumor and you didn't have any money, then, you know, tough—surely that would have been an enormously expensive procedure. | ||||
| Jonathan (16:51) | I would say not necessarily, because there was a network of voluntary hospitals up and running. So, for example, the London teaching hospitals, they weren't flush with cash, but they were effective voluntary institutions. So in fact, if you had a—just as tumor surgery had got underway in the '20s and '30s, a reasonable number of people were being offered operations at that point. So there was—there was some provision for healthcare; it's just that of course it was suddenly much better arranged and organized. And the other big effect of the NHS was because the surgeons were all paid a salary, as we still are for working in the NHS, it meant you could put units anywhere. Whereas before the war, surgeons tended to be concentrated around places where they could do some private work, because they weren't paid in the old voluntary hospitals before the war. They were, as the name suggests, doing it for nothing. So you would only have been able to work somewhere where you could do private practice on the side. But once you started paying everybody, suddenly you had a national network, because you could go and work in Hull or Preston or Bristol or Plymouth and you would have a living. So that—that just that economic shift would have made a difference, because it meant the specialists suddenly appeared in all the regional hospitals—not—not suddenly, perhaps, but over a period of decades. | ||||
| James (18:14) | Okay. So we're coming out, we've now got the white heat of technology in the late '60s and big developments. Are we seeing improvements in neurosurgery through that time, through the '60s and '70s? We're getting better imaging, presumably. | ||||
| Jonathan (18:29) | Yes, that's right, yeah. I think you could probably say post-war was sort of in two phases. I guess you would say early post-war was to do with unit building, putting teams together, improving the service. And then that was followed by improvements in imaging. So, for example, before the war in this country, we didn't use much in the way of angiography, which is sticking dye in the arteries to get a look at the brain. That came to the fore after the war, so the papers on that are sort of 1940s, 1950s. So that meant you could start to see the brain better with angiograms. But the big imaging shift that we're all of course now familiar with, because it's the way we look at the brain every day now, is scanning: CT first, early '70s, and then MRI from the mid-1980s. So those two things made a huge shift, because of course you could now accurately see what was going on, whereas with angiography and the X-ray techniques that preceded it, it was a much more crude way of viewing the brains. If you keep coming forward from that, what was added to that was our ability for radiologists to take on some of the treatment of the brain. So once you've—once you've worked out how to cannulate or stick a—stick a cannula into a vessel, then of course you can do some treatment through the vessel. And that's where we are now with embolization blocking off vessels to reduce blood flow to tumors, extracting clots from vessels, which we now do in stroke as a routine thing. So embolectomy, or taking a clot out of a patient with a stroke, is a routine thing now, and that's the sort of end, that's where we've got to with imaging. It's gone on so far that it's a therapeutic thing as well as just a technique visualizing things. So that's one side of all of that development. And the other is that technically various things came in to improve, well, essentially surgeon's vision. I mean, the big—the big shift in neurosurgery was the introduction of what's—what's known as an operating microscope, which sounds like something that's giving you a tiny, tiny view of what you're looking at, but actually the magnification in an operating microscope is not that huge. What it does is it gets light into a small wound, so you get a brilliant view, and it gives you a low-power, but—but important magnification. And you also have 3D vision, and you have good depth of vision. And that shift, putting a microscope into the wound, for things like treating aneurysms, tumors, made a huge difference, because it meant you were handling the brain more carefully, you didn't have to sort of, for want of a better term, push the brain out of the way to see what you were doing. You could work in—within the brain without needing to, as we call it, retract the brain, in other words, you don't have to push the brain out of the way, which makes brain extremely unhappy. So brain is happiest when you don't touch it at all, and when you are working on it, you touch it to the minimum amount possible, and the microscope allowed that to happen. So that was late '60s. And then that in turn, that if you like improvement in visualizing what surgeon's doing, was added to by the endoscope, operating telescope, which gets you into all sorts of cavities around the head, particularly the base of the skull, so you can look up the nose to get to the base of the skull, and various refinements of those types of imaging. There's a more recent device called an exoscope, which is another—essentially another way of getting light and magnification into the head. | ||||
| James (22:07) | Yeah, and being able to kind of see what you're doing, I guess, is going to be important, right? | ||||
| Jonathan (22:10) | Definitely. | ||||
| James (22:11) | I'm sure that people listening to the podcast will have seen surgeries where the patient is conscious. When did that start? It seems just a bit weird and scary, but I guess what you're doing is you want to make sure you're not damaging parts of the brain while you're operating. | ||||
| Jonathan (22:28) | Yes, yes. And it's actually not remotely new. That—that surgery was done from the 1930s. It was first done in Montreal by a guy called Penfield. It's worth remembering there are a few conditions kicking around where there was no non-surgical treatment, and one of the most important of those was epilepsy. So fits were not treatable by any means other than an operation in—in those early years, and the drugs all came in later. So in the 1930s, there was a real pressure on surgeons to find ways of treating epilepsy effectively. And so what Penfield did was he used to operate on patients with seizures when they were awake, because it was by far the safest way to find your way around the cortex. It's actually remarkably safe thing to do because the brain itself has no pain sensation. So provided your patient's comfortable and you've—you've opened the—the head painlessly, it's a safe thing to do, and as I said, it's actually a very old technique. The bit that's changed in the last few years is it's become more frequent to use it for treating tumors. It wasn't really a thing, as you can imagine, when imaging was poor, then there was no incentive to do what we would call a radical removal of a tumor, to get every bit out, because it was often very difficult to tell whether you'd got every bit out if you weren't imaging with CT or MR. But since imaging has got better, and the incentive to remove tumors more radically has—has come to the fore, awake craniotomy has come in. And we know that there's quite good evidence that for certain tumor types, particularly what are called gliomas, so tumors that spend their whole life growing within the brain, those tumors tend to do better if you can take more of them out. Some tumors it makes less of a difference, and some tumors have such a sharp margin that you don't need that sort of help, but certainly it's one of the things, one of the tools for getting the maximum—maximum volume of a—of a tumor out of the head, yeah. | ||||
| James (24:49) | Yeah, that's interesting. I guess with some kinds of tumors, knowing where tumor ends and healthy brain starts can be a bit of a challenge. Are there technologies that help you distinguish between those things? They might look the same, I'm guessing, in some cases. | ||||
| Jonathan (25:01) | Yes, that's true. And in fact, there's more of that technology than there used to be. So, for example, we've got intraoperative MRI now, so several units have got MRI scanners where you can get a scan on the table if you want to. We have intraoperative ultrasound, which is, you know, a handheld probe that shows you the contour of the brain, shows you the interface between the brain and the tumor. Within the last 20 years, 20 25 years, it was found that there was a fluorescent dye which would help define the limits of a tumor. That one's applicable to cancerous gliomas, malignant gliomas, and that has been in use now for at least two decades, and that helps you to identify the margins of the tumor. But you're right, these anatomically to the naked eye, some of the margins of tumors, especially gliomas, are not particularly well-defined. So with those extra tools, you can be clearer about where the limits of—of what you're treating are, yeah. | ||||
| James (26:02) | Right. So here we are, 100 years since the formation of the society. What does the future hold? If we come back here, Jonathan, in another 100 years' time, will robots be operating for us without people there? | ||||
| Jonathan (26:18) | Well, it's—this is interesting, isn't it? Because it is—it is really speculation. You know, you're—you're—we're sort of guessing, really. So if you kind of project backwards 10 or 20 years, you could—you could—if you look at my career, what do I think's made the impact in that time and therefore, you know, where might that go? I would say one thing which has quite radically changed is the way we diagnose tumors. So diagnosis and classification of tumors might not sound terribly sexy or terribly surgical, but in fact, that is having a huge impact on how we treat patients. And examples of that are tumors, for example, where it's now obvious that chemotherapy will be beneficial, and we know that because we got more information from the pathologist than we had 25 years ago. So those kind of changes in diagnosis, classification, and prognostication, you know, telling the patient where things are going to be going, they make a huge difference, because some—quite often those techniques lift a subgroup of patients out of needing an operation. You know, we know if we do a biopsy and we get enough information about a tumor to tell us that it will do better without surgery, you spare that patient open surgery. So pathology and diagnostics have changed a lot and will carry on doing so. And just to give you an example, this is a bit pie in the sky, but when you think that on an MRI scan at the moment, a radiologist will probably give you, for some tumors, will give you a shortlist of what—what you might be looking at. He might—he or she might give you two or three possible tumors that you could be looking at on that scan. If you project forward a little bit, diagnostic techniques are always getting better, so I would be surprised if some of the tumors that we now biopsy need a biopsy in say 20 or 30 years' time. You know, we might be more confident about getting the diagnosis from the radiological information available. So I suspect that will change going forward. So diagnostics, both in terms of radiology and in terms of pathology, I'm quite sure will carry on improving. And then the other thing which I'm sure will carry on happening is that we get better at doing operations through smaller access. And the big example, probably the best example in my career, is that an aneurysm, which is a kind of blowout on the wall of the vessel, where you get a bleed into the space around the brain, the subarachnoid space, those hemorrhages are extremely dangerous things, because the brain's very vulnerable to even small amounts of blood sitting around it. So those aneurysms used to—used to all be treated open. You'd open a window in the skull, you have the patient asleep, the brain is relaxed, you find your way under the brain, and when you've get—make your way to the aneurysm, you put a clip on it using the operating microscope. So that technique came to the fore in the '70s. And then when I was training in Oxford in the 1980s, a trial was initiated in Oxford of a completely different way of treating aneurysms, which is to place a coil inside the aneurysm. So you don't open the head at all, you feed that coil in through an artery, usually accessed in the groin, and that the coil is a very neat little device which has a—which is a pre-formed ball, a little bit like a ball of wool, but that ball of wool can be straightened out into a feeding catheter. So you—you feed the tip of the catheter into the neck of the aneurysm, gradually unravel that little—that little metal ball into the aneurysm, pass a current through it, it coagulates the aneurysm, blocks it off, catheter comes out, and you've treated that aneurysm from within. So you haven't had to expose it at all. So you can see that—you can imagine the shift that has produced in the number of patients going to a craniotomy for aneurysm surgery. It's absolutely seismic. These—these were operations we were doing once or twice a day, and we're now in my unit, we're doing them more like once or twice a month, because the vast majority of those aneurysms are fit for coiling. | ||||
| James (30:58) | It's interesting. It seems like, yeah, all the things that you've just been describing are all things that mean you do less neurosurgery. And I guess it comes back to what you were saying earlier about, you know, if you can avoid touching the brain, then avoid touching the brain, right? So this is all really positive stuff, much less traumatic for people to have that kind of treatment through—through the—through the blood vessels rather than having a hole cut in your head. | ||||
| Jonathan (31:22) | That's right. And I think there's one other important shift in care, which takes us back a few more decades, but it's worth bearing in mind that the anesthetic care and ITU care that patients have had from the time roughly of the early '70s has changed radically. So if you look at how the brain was treated in the '50s, for example, if you were unlucky enough to be thrown through the windscreen of your car in the '50s, generally speaking, you were nursed on a head injury ward and you had a great deal of very careful nursing, but essentially, you were looking after your own brain. You were breathing on your own, you were keeping your oxygen levels up, and the nursing was all about looking after you while you healed your brain injury. Once it was discovered that a bit of support to the brain, keeping the blood pressure up, keeping the oxygen supply up, actually helped brain survive those sorts of injuries, that there was a big shift towards intensive care, and that's why a lot of patients are ventilated, kept to sleep on intensive care at least for a short period—shorter periods perhaps than they used to be—but that kind of treatment, what—what you might loosely call supportive treatment for the brain, has completely changed in the last—in the last four or five decades. And that—that's made a big difference, because it's—it's lifted a group of patients who would have done very badly from a brain injury into a much better outcome group. So that was—that was another big thing that's changed. And if you look at where that's heading, what's happened over the last few years is because of trials, it's become clear, you know, who will benefit most from which intervention on ITU. So there have been a few things around head injury showing that in a subset of patients, if you take some bone away after a brain injury, you get a better outcome. That's been an important—and that kind of work comes from an understanding that by doing randomized trials, by having patients in separate groups, treating them differently when you really don't know which way to go, and then comparing the results, starts to give you much better targeting of what you do. So—so the quality of the what we call the evidence base, the quality of the—of the information that's driving us to treat a patient in a given way has improved a lot in the last few years, and that's clearly going to carry on happening; there's not going to be any let up in that. You know, trials are—we know that trials are the best way to describe the benefits of treatment, whereas in the past it was more a case of writing up a series. You'd say, "Look, I've done 30 of these and they've all done very well." But somebody else might say, "Well, if I'd done those 30, you know, would they have done as well? You know, if—if I treat those 30 in a different way, will they do better?" And of course the only way to find that out is with the trial. So trials have become the driver, the main tool for proving the benefits of neurosurgery. | ||||
| James (34:19) | Yeah, absolutely. And I'd be told off if I didn’t at this point just say that recently the Cambridge brain injury team been awarded an NIHR Impact Award for their research in developing new guidelines and treatments for brain injury. And I was one of the people that was cared for in Cambridge, and I went through the process that you've just described: I was kept in an induced coma for about a week, had a little hole drilled in my head so they could monitor the pressure inside there, but that meant that they could see what was happening, and I wasn't rushed to surgery because I didn't need any surgery. So again, another example of these cases where actually we don't want to just go sawing the top off somebody's head straight away; let's see what we can do without having to kind of go in there. | ||||
| Jonathan (35:05) | Indeed. Yeah, absolutely. Yeah, I think—I think it's fair to say the best way to predict the future is look at where we've gone, you know, in the last few decades, and you can see trends that I'm sure will continue. | ||||
| James (35:16) | We have this huge conference happening in October 2026. If you're listening to this after that, you missed it. Bad luck. But there are going to be about 2,000 people coming, they're going to be specialists in neurosurgery from all over the world coming together, kind of sharing experience and reflect on the things that—that we've just been talking about, Jonathan. Is there one key message that you would like everybody who comes to the centenary conference to take away from that event? | ||||
| Jonathan (35:46) | Well, I think it'd be quite nice if we sort of shared the excitement of how—how much development has happened, I think. I think we will be doing that, because there's a—there's a nice mix of sort of earlier work, describing what—how things started, and, of course, an awful lot more of recent work. And I think—I think it—it IS an occasion where—and this isn't perhaps the norm for us—where we can look at that whole spectrum, see where we started and where we've ended up. Normally, we're very much focused on, you know, the now and perhaps the last 10 years. Most people who stand up at conferences want you to think they're handing you something brand new, but of course that becomes even more, you know, it becomes even more impressive if you just take the time to briefly look at—at what that represents in terms of where we've ended up. So there is a bit more history stuff in this meeting, and I think—I think it'd be nice if—if the excitement of how much has changed and how quickly is shared a bit this time, which might be a little bit different to the average modern neurosurgical meeting. | ||||
| James (36:58) | Well, let's hope we'done some of that by recording this podcast! And that seems like a nice note to wrap up. So, Jonathan, thank you ever so much for joining me on the chat this afternoon. | ||||
| Jonathan (37:07) | James, thanks very much. | ||||
| James (37:08) | If you've enjoyed listening to this podcast, do check out any one of the many other episodes that have been recorded. You'll hear from patients and carers and researchers and clinicians and anybody with any kind of interest in brain injury. Thanks for listening. |
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