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And now uh we have uh currently at Oxford, otherwise that is Bristol Outreach East. And he's going to tell us about their skull base surgery. Thank you very much. Thank you. It's a real pleasure to be back at headquarters. So, thank you. I uh I normally give this talk pretending uh to be at Oxford. But next slide, please. But as we all know, really, it's Bristol Outreach East and I'm here to talk about uh the eastern front and skull base surgery there. Um Next slide, please. So I was given some very clear mission objectives. When I left, we wanted to know whether there was any neurosurgery outside of friendship. We weren't sure there was and they wanted to know of people at the Bristol Outreach. Each that hurt a skull base surgery. You can see David Porter in the picture. They're giving me some advice. He's pointing a gun, sort of standard advice from David Porter. I think he said to me as a consultant, you can shoot any registrars on site. I don't know it was related to the conversation, but it was good general advice as I got from Mr Porter. Um So Yeah, those are my mission objectives. Obviously, there's a mission debrief next slide, please. Yeah, so it's um it's a dangerous place out there. Um That's why they send the top guy. Well, I say top guy, I think Sonny Carl was busy. Kevin sang, realized I was better private practice in London. So they sent me um, Rick is giving me some tips pointing out where the skull bases. I've got that. Usually look at my face going, I've got this Mr Nelson, unfortunately, point of the jaw or something. Luckily, he zoomed in and this would be pointing the sternum. Um And uh you know, he goes on to say it's very important to have a targeted focused micro surgical radical extensive which one? I had a different look on my face. Uh Sure. But anyway, I got the message approach to surgery. George Malcolm was ready to speed me to Bristol Outreach East in the Trustee RAV four. I understand there's been livestream so you don't have the whole picture is obviously sensitive information. We can't show the whole RAV four. But Mister Malcolm was ready to speed me there. We had a chat about it. We thought it was a complex mission trying to work out how to get into the RAV four, which is always difficult at that time would only add complexity. So I took my rather tall golf, uh next slide, please. So I got there and it was bad as we thought, uh, you know, the picture on the left you can see it's super old. A lot of pointy buildings, not well lit. Don't be fooled by this very good iphone picture. It's not well lit. Uh, bottom writes the library. I try to get a book on skull base surgery. Apparently it's not a lending library. Something about Charles. The first wasn't allowed a book hundreds of years ago. And I jolly, well, can't have one either. Anyway, um People dressed like that bottom right picture. They think it's normal to go for dinner like that. I don't know. Anyway, the top right picture is either a Turner painting from the 18 hundreds of the Oxford High Street or last week. I mean, it's hard to say, it's hard to say in Oxford. Okay. Um Anyway, I was there next slide, please. This was the hospital from 17 hundreds. Thank God removed. Uh You can see it's very, very old like everything else there. Um They've done some work in antibiotics, but I got excited initially, then realized it wasn't kept track. So sorry, I immediately lost interest. Um Harvey Cushing was visited Hugh cans, of course, set it up. Uh I wrote a paper on you cans but I'm not sure what he's done fully. I mean, those things are mutually exclusive but he, but he has, you know, did a very, very good thing for uh sorry for Paul or Oxford neurosurgery. Uh He trained Diana Beck, who trained most of the current consultants now who work at Oxford, so did a huge, huge service, uh talks to neurosurgery over the years by training a lot of us here. Um Next slide, please. Uh This is the team. I've got a big team and the reason I've got a big team uh in Oxford scalpel surgery is I don't have Rick and well, David Porter or you Coke. Um So I've had about 20 other people to replace them. Uh I always think of this slide when I give this presentation a brick. Uh I spent a week working for him where we did a whole bunch of various cases. We did an ecic bypass and acoustic and all these, we didn't. Alef and I said to Rick, should I get I get vascular surgery? And Ricky looked at me that usual look, which was, you know, who hired this guy? Why is he on my team? Uh And he said to me, what are they going to do in the operations? I said, okay. But anyway, so I have a whole bunch of people. Uh and they are useful. Uh The legacy of my colleague, uh my predecessor, Richard. Uh It means that we can do a lot. You know, there's a whole, I'll show there's a whole range of operations we can do. Um Next slide, please. Anatomy is key. And I think, you know, we all understand that skull base surgery and I'll pretend to talk about scallops surgery a little bit during this talk. And uh anatomy is hugely important to skull base surgery. You know, whether you're in the cabinet, sinus stands, bearable fish is very difficult endoscopically going for a far lateral. But really on a personal level, I think I'd have to say that anatomy for me is it's just so so important because it's a fantastic pretext for this next slide. Next slide, please. And this is my, this is my favorite slide in the whole talk. Uh No, seriously though I was very impressed while I was here and I was obviously Bristol Consults had amazing knowledge of anatomy. Uh stood me in really good stead as a consultant. Uh I was very impressed by George Malcolm who was very open. It was a senior consultant that we're all constantly learning. Uh Obviously, that's that picture on the left. Uh You know, even he sends me this picture saying I'm still reading and I am too. Uh And, and that was a great lesson I think and I, that I passed on to the trainees, but I think it's also important not to send compromising pictures of yourself. So I think that's also an important lesson. So if you are approached by Neil Barua, the bad boy of neurosurgery here, please don't provide him with any pictures. Okay. Uh You're probably wondering what the picture on the far rightists. A lot of you. I'm sure we'll know that's obviously George Malcolm's hugely popular podcast. You, some of you probably seen it. It's called Floor Plans of South Meat Hospital. It's amazing. This episode is on lifts. It's really good. I recommended. Um, you've probably been wondering for years, what is George Malcolm been doing it 2 to 3 in the morning running around the hospital, haven't you? Well, he's running a very successful podcast. Okay. That's what he's doing now. You know, I'm sorry to let the secret out uh in the middle picture. Of course, combines both his great passions. Good. Next slide, please. Right onto the report. So we do a lot of difficult cases. They obviously go extremely well uh for two reasons. Uh One is I trained in Bristol. Secondly, I'm only going to show the cases that went well. So that's my, that's my top tip for presenting. Okay. Uh We do a huge range of complex cases. So that's, you know, the endoscopic chordoma we did there on the top left uh difficulty tree climber, meningiomas, Peters, Meningiomas logic. You see all sorts of things both combined and open. Uh Next slide, please. Uh And that team I mentioned earlier, incredibly helpful. Uh we can go anywhere TMJ orbital tumor's as an orbital orbital tumor removed with normal vision, normal eye movements. Uh We get very good functional outcomes. Um Next slide, please. I put this one in uh another difficult case that's gone. Well, um Thanks to, you know, people have trained me. Uh Rick Nelson of course, taught me how to do acoustics. And I first started, he's also the reason I almost failed FRCS Operative station because he does this very focused, targeted small retrosigmoid craniotomy, which I described in the FRCS exam very proudly. And the look on the examiners face for this small craniotomy almost got me thrown out, but I got through it. Um David Porter seem to enjoy doing a lot of vascular tumor's. I particularly remember doing a difficult hemangioblastoma stuck on the vein of Galen. I may have pulled on it a little bit hard. David Autor comes into the room at that time and I sort of look at him and this sort of you're gonna scrub up face and I back it up with the sucker sucking huge amounts of blood up quickly and he sort of sits down, pulls on a newspaper and says you picked a fight with it, you deal with it. So really excellent. It was good. It was all very good. Uh, uh, we do this well, uh I guess I don't embolize them because, you know, we don't do that Bristol thing. Uh, next slide, please. Um I'm very glad Professor Coke um, is here my introduction to Scale based surgery was a Professor Coca. My, so she give you some background. So I did six months and I said sure, I've done a lot of general surgery. I did six months and more tells me I should become a registrar. She said we'll look after you. You'll be in Plymouth. It's all, you know, it'll be easy. I said okay. And then they sent me to Bristol and it was all very exciting here. So I've done six months and I said to, I'm now registrar. I'm covering Professor Coke. Um, uh, lucky there's Matthew Garner that's Crispin Week Field as, uh, Nik Patel. It started as a local consultant. So I go to them for advice and it's all very reassuring. I'm, you know, very confident that I definitely don't know anything after I speak to them. So it's all going very well. And I'm doing a case of professor, any patient that sleep in the anesthetic room. We, he puts up the MRI scans and he goes, uh we're gonna go trans petrous old boy and I was like, I must ask Crispin how to spell that later. We didn't have Google back then as good. And he explains it to me. He says, you know, really important to have ent and I say yes. And he looks at me, I look at him. He says, have you got a nt and I say no, no, no. And he says, don't worry, oh boy, don't worry, we don't need them. Uh And in true Professor Co Confession, which I've been aspiring to the whole time since then. He, he took the tumor out by five o'clock. I don't know. It's a retro level what he did finish by five o'clock. And I've been expiring too that finishing at five o'clock and not having Ent has really been my goal and it's a work in progress. Um Professor Coke, um, also very kindly sent me to, to Mass General to Bob Catoosa and kick started my research career. Uh I don't have any nature cover papers to show you. Uh, that's also an aspiration. Uh, but I'm really focusing at five o'clock thing at the moment. So, you know, I'll get to the other thing. Um This is a uh approach I really like, it's a very useful approach combined petrosal uh where you do anterior posterior septum ease and it sounds difficult doing that. Uh you know, drilling at depth until you remember that the first time you really had to use the bird was with David Porter, scrubbed up with you, uh drilling it very, very carefully on the juror. And you think, well, actually drilling between the trigeminal nerve and Crowton thinks it's not as, not as stressful as that. So that's okay. So it's all, you know, and after he got me started off with that, I have now decided I must put the drill in every deep bit of the skull I can and remove bone. And it's been very good, but it's very useful approach. Um I'm showing one scan will show another one. I I use it a lot for Peter's meningiomas buttock levels. Uh some Chordoma Sandra socks. Uh The picture I show the black is the drilled bone. It's a bit of a small picture. But on the left side, the pizzas apex is gonna skeletonized. I am the cochlea and posture Beatrice's gone. Uh And we get very good results. We can protect the hearing. The top corner slide is a very excited ent surgeon telling me the hearing is actually better post operatively, which is very exciting. Uh So, you know, I think I should be too harsh. There are some uses to ent surgeons. So uh next slide, please. Uh Yes, I think uh that was, you know, a lot of what I wanted to cover. Uh I won't show the videos in the interest of time. As I can see, I'm already at 12 minutes. Uh But this is a large pizzas manager where you can take this out. They do very well uh neurologically intact. Uh We can see let's go the next slide and then we can skip to the one after that. Uh I won't show the video but I'm available at all. Good neurosurgery webinars near you. So you can watch that. Uh I just go to the next slide. That's the video of the operation. But again, entry prostatectomy is cutting the tent and the sort of standard micro dissection patient does very well. She ran a half marathon uh showing how well she was uh eventually the decided to run a half marathon raise some questions about what I may have done during the operation to her cognitively. But anyway, it's fine. Um Next slide I put in some endoscopic stuff because I know Rick is retired and I know you don't really have an endoscopic surgeon. Um Not one that's doing very many and definitely doesn't mention Stanford. Uh So, so, so, so this is really CPD for the Bristol team. You're welcome. You know, uh we do a few endoscopic cases. Uh This is a malignant peripheral nerve she tomb in the tele go proton fossa. I won't show the video again, you know, you can take them out very nicely. Endoscopically. Next slide, you have to label the endoscopic slides because who knows what the hell is really happening? That operation could be anything, you know, they tell you anything you have to believe them. Um And yeah, so the next slide, please, I think it's a nice, nice result there. We got that out nicely. Uh And then yeah, the next one, next slide, please. Uh I think I'm coming to the end of my time. Um The video I do want to show us right at the end. The next one is the Treasurer Sonoma, which you took out and this copy is a video there, but I'll skip that. But again, you know, extra, the pathology is really nice uh endoscopic work because you can claim a very low CSF really great. So I, I recommend it uh that's very good. Next slide, please. Um So I think the point really is that uh next slide, least the point really is that, you know, we, we do a lot of good work and I've got a great institution and, you know, great back up behind me. Uh Next slide, please. But I couldn't, I couldn't have done any of this. Uh If it wasn't for my time in Bristol and I feel really lucky and, and really grateful for that. Uh I think the consultants were amazing, you know, really interesting training, very inspiring. Uh Absolutely loved my time here. Uh It wasn't just the consultants, it was everybody else friendly, had a real can do attitude, the nurses, physios, everyone, everyone's absolutely amazing. Uh And I can't forget the trainees, you know, so impressed by the senior trainees and things when I first came, uh my own group were amazing. You know, Sonny Kevin, everyone, uh the people after me were very, very uh impressive and I feel really lucky, really grateful uh to be a part of French. I think we all do. Uh I think, you know, no other institution could really replicate that. Uh And I'm very grateful for that. Uh So thank you very much and for all of the reasons I uh I, I said at the beginning and so for all of the reasons I just gave, uh it's a real pleasure uh to be back at headquarters. Thank you. Uh Thank you Sanjeeva and I think we have a recorded talk. Do we still or not? No. So, um Mario is going to kindly make some closing remarks.