Awake brain surgery for gliomas is something that is very close to my heart and I regularly undertake these at the University Hospital of Wales. I find that there is no other standard that can match the benefits of monitoring important and socially enabling brain function with someone who is temporarily awake during their surgery. This I learnt from Professor Hugues Duffau – a doyen of awake brain surgery for low grade glioma with whom I spent a few months in observership at Montpelier in the South of France. I truly believe in pushing functional brain boundaries to achieve maximal tumour removal while preserving what makes one a normal functioning human being capable of spontaneous and enjoyable social interaction.

Diametrically opposite to brain tumour surgery – in both principle and approach, lies my other but equally passionate interest in Facial Pain. Trigeminal Neuralgia is rare – but can be one of the most painful and invisible conditions known to man, and often undiagnosed for many months or years. This is because other conditions that mimic this pain are so varied that they require the expertise of different clinical specialists – and a lot of them may not be available to you locally. However, there is a good proportion of us who are very suitable for a range of treatment options from simple medication to microvascular decompression surgery. The challenge lies in choosing the correct option, and the dilemma will be in balancing risk vs benefit.

Moreover, the guidance on medical management continues to evolve and it is important that the correct first line medications are prescribed to corner the pain while investigating for any potential causes that are remediable. Conditions like Glossopharyngeal Neuralgia and Geniculate Neuralgia are far more uncommon but have excellent outcomes with Microvascular Decompression surgery – as do a large proportion of people with Trigeminal Neuralgia.

As part of my NeuroOncology remit, I also have expertise in Spinal Cord surgery for tumours – both within and outside of the cord. However, these are more rare in occurrence than tumours elsewhere in the central nervous system.

Notwithstanding the above, I do routinely perform surgery for degenerative spinal disease of the neck and the lower back within my NHS practice.

At the University Hospital of Wales, I am the Lead for Neurosurgical Oncology and the Welsh Cancer Lead for Brain and CNS. I also Lead the Facial Pain Network in South and West Wales.