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And so um it gives me great pleasure to introduce uh Mr Mike Pots, who is an emeritus professor, not Professor Emerita consultant in Bristol, very keen golfer, expert in car mechanics. As I found out when he fixed my camper van, which was leaking petrol everywhere and almost probably saved my life. I think so. Thanks Mike. And he's going to talk about his um years working with the neurosurgeons. So, thank you, Mike. Thanks very much. Nice to see you all. I've known many of you for a long time. So 20 years, not thumb ologist with neurosurgeons. So my early connections. So I came to Bristol in 1970 to do physics degree uh and then got interested in medical physics uh and ended up doing a phd with Professor Richard Gregory Brained Perception Laboratory uh in 73 76. And while I was there, I went to the burden. So that's my first contact with French Air. And the burden uh started doing electrophysiology with the burden had a PDP 11 Christ that was the biggest computer uh in the country at the time. And uh that was impressive and also started to go to the Wednesday. Another thing that we've forgotten at French, uh, is the Wednesday lung time meetings that we used to have. Multidisciplinary. You know, it was great. You'd have a radiologist. You'd have neurosurgeons, you'd have physios. Everybody was there and you discuss cases. So that was my ex experience. Uh, I've then decided to do medicine because everybody said, oh, it's the doctors that have all the fun. So I thought, well, I'll join that, you know, and actually Charlie Marks and I uh I taught Charlie Physics in the first MV for a little one year and then we were together and medical students in Bristol. Uh So in 1988 1918, I became, I did foreman supplementary house officer attached to Hugh Coke, um and Brian Cummins and, and, and the big, the big four and I studied the recovery from head severe head injury, had a little uh one of those um devices with colors and sound and it went don't do. Uh and I go around all these people with head injury and plot their recovery uh from severe head injury and presented that at the Wednesday. That's why the Wednesday morning meeting was important. So in, in I maintained my interest in 81 I qualified from Bristol and uh started at Bristol I Hospital as an eye surgeon uh with interest in neurosurgery and neurology. Uh and I went to more fields uh Mike Powell and I met more fields uh, Queen's Square, went to Queen's Square did all the right things. And then in 1991 I got the job I really wanted was to come back to Bristol. I Hospital. Uh, not only that I wanted a session at French, uh, to come and do some neuro and, uh, things. So that's, that's a long, uh, yeah, that's nearly 20 years. Actually, it took me 21 years of training from 17 to 91 to come back to Bristol as a neuro as an ophthalmologist. Uh Is that my early connections? This one advance? Oh, it's this way there we are. O2, 2. I'll get it in a minute. Go back a bit. It's on the way on. Uh Is it number 21? Uh don't legs and no, no, no, I'll go back, keep going back. Uh go back, go back. Yes. Uh next one. Right. Ok. So, um as well as uh I've been appointed, uh I came to French once a week to do an outpatient clinic uh on a Monday afternoon at French, eh, and I knew all the people and, and you, you know, uh Brian and on all the people and Charlie uh and in my clinic on a Monday afternoon, uh when I first arrived my predecessor, Mr Dallas hadn't been really interest in Europe some old your abs and I got these letters of referral, dear, Mr Potts, please. Could you do a formal visual acuity test? And visual fields. No, no, that's not what I've come to do. Uh The problems were uh Dave pointed out there was always some problems. Um There was no snelling charts on, on any of the neurosurgical on your old George. Uh There was no fields machine. The only fields machine was Hugh Griffiths. Hugh Griffiths had his own jerry screen in his room. He used to pull the Jereme screen down and, and plot the pituitary visual fields. So, so we went and got about, we've got a Humphrey visual field machine installed. Uh And we got a visual field service going that, that anybody could use neurologists and neurosurgeons, neurosurgeons. And then probably most importantly, where I met most doctors and they would say, oh Mr Potts, I remember you was once every six months, I'd teach the New House how to do a visual assessment uh every six months and said this is what this is your job and this is what I expect of you. I'll see any patient's and I answer any question, but uh give me the basics first. So, so that was early experiences. So then the robot years. So Dave Sanderman and I were appointed very similarly years together. Uh And I was also appointed at Bristol Hospital to be the Southwest regional Orbital Surgeon for the whole of the Southwest. They've never all orbital surgery used to go to more fields uh because uh political reasons. But, but I, I came back and said, right, we're going to do orbital surgery in Bristol. Uh I met Dave Sanderman and I realized that with increasing complex orbital and orbital cranial cases that Dave's magic. And as we've already heard about it was really good for helping me navigate in the orbit. So things like complicated sphenoid wing meningioma is where once you've gone in the head, you really didn't know where you were, that they were great for doing that. And so I did lots of collaborative stuff with not only Dave, but the other boys as well tried to raise the awareness about neuro ophthalmology because Neuroophthalmology, well, you all know a visual field can tell you a huge amounts about where the things are on what is and, and the one thing that people wake up boys would say, might I get a phone call, might have been in this head guy's head for eight hours. Now he's woke up. He's got a bit of double vision. Can you just come and give him a prism, whatever anyway, but I'm I joke. But uh it's important for the patient and for a thing. So I was uh Dave was the first neurosurgeon to have the magic wand in, in the UK. And I was certainly the first orbital service in the UK to have access to uh navigation and, and uh and the wand and now navigations regarded as routine for both actually neurosurgeons and for orbital surgeons as well. Let's just press slowly. I keep I'm too strong. So uh oh, there we are weight. Go on, move on. I pressed to you on the way out early connections. Robot years or more science. Okay. Let's have a bit of science for a minute. Alright. So I'd like to make a case while I'm here for a case for optic nerve chief ministrations has been the best operation for fulminant. Iih and other forms are raised intracranial pressure for 20 years. I did optic nerve she administration at the eye hospital um for a raised intracranial pressure and most of the neurosurgeons were very pleased that they didn't have to shunt these paper and I took them on because IIH patient's are not the easiest patient's. Uh certainly. And I do think there's very good evidence uh since I retired, uh optic nerve defenestration has fallen a little bit out of popularity. There's no good reason for that. Uh The two people who took my job found it a bit challenging and didn't want to take it on and do it. Uh And I think there's good evidence that optic nerve sheath penetration is far superior to shunting for uh former NIH and possibly other things. So let's just look at some evidence for. So what the advantages of an ophthalmologist doing an optic nursing administration is that we're already involved with the patient. Often as an ophthalmologist, visual fields and visual loss, we've got good access to the assessment of optic nerves with a visual field, machine, octs and funders imaging. We've got a good feeling for when papilledema that is really bad is going to go blinding. Uh And, and that's not easy because papilledema Czar now not an easy thing to assess and to know when people are going blind, fulminant is difficult diagnosis. We're not so pressurized a neuro surgeons. Uh I think it's probably best to do both sides Optic nerve. And I think we're beginning to the new uh CSF pressure measurements that going on with radio control show that we get spikes when you walk, you get spikes of pressure, 50 millimeters. And I think in full and the CSF is forced down a tight canal, there's a non return valve, it can't get back up and you get a big cuff of high pressure around the optic disc. And that's another reason why optic nerve sheath penetration works when, when a shunt doesn't, you might have a pressure of 30 in the ventricle or 25 or normal. But if the pressure around the optic nerve head is 40 or more making a hole where the pressure is high is the important thing. It's a simple cheap operation. Uh 45 minutes by me doesn't require an expensive shunt and I think it works. Works well. Um Try that. Mm. Come on farms. Well. Oh, yeah. Maybe that I've seen. Wait. Oh. I was on that one there, isn't it? That one. Yeah, but it wasn't. That's right. Okay, thank you. So, well, this is just the disadvantage of you doing it. Uh It needs to be referred to you in the 4 to 6 weeks it can take to get from, uh, you know, the eye department to the, it can go blind and it's an emergency needs to three weeks. Uh It's low on their list. Poorer access to optic nerve function, poorer feeling for the papilledema doesn't lower the intracranial pressure at the point of pressure. Uh And most, most neurosurgeons don't like it. And very happy. OK. Enough said for that, let me try one more. So, the legacy. Uh So what have I uh we still have excellent community connections and potential for collaboration. I think between ophthalmology and neurosurgery, it's bedeviled as uh we've already heard about the differences between Bristol with two hospitals. Ophthalmology is in uh UBHT and, and neuro neurology and neurosurgery is in North Bristol. They found out when I retired that they never paid you BHT had never paid North Bristol for my services. And uh and then, so that was a little difficult to get another person to go and we haven't managed to get another one. Neuroophthalmology is currently led ably by Luke Benito is a neurologist at, at uh North based, I'd like to re establish it possible having an orbital ophthalmologist come to North Crystal. Uh I'd like you to have a bit more fully equipped your opthalmic assessment, uh get some octopus and visual fields. You've already got an oct in Humphrey fields, but so you're nearly there. Um Let me just point out Birmingham as the same unit as you. Very good. They are supported by five full time neuro ophthalmologists, five plus staff and North Oxus and things. And so enough said I'd just like to say I had, I had a blast. I had a great time working with the neurosurgeons. A really good time with the French and neurosurgeons. Thanks very much. Cheers. Thank, thank you very much, Mike. Uh.