Fellowship in Functional Neurosurgery and Complex Epilepsy

Job responsibilities

The Post

This post is intended to provide service cover in all aspects of functional neurosurgery (epilepsy, pain, spasticity movement disorders and resection in eloquent area). The fellow in Functional Neurosurgery will participate in the neurosurgical specialist registrar on-call rota. The Trust currently has a 2 tier system for the on-call, the 1st on-call are the more junior trainees and the 2nd on-call the more senior trainees. The amount of time dedicated to the functional syllabus will depend on the tier on call if on the second tier then the 1:8 on call will occupy approximately 20% of the individuals working week leaving 80% for functional work; if on the first tier then these figures are 40% and 60%. If the applicant has a completed CCT then he/she can expect to be on the second tier, but this will be assessed by the Clinical Director following appointment.

The fellows will be encouraged to be on call with the 2 functional Consultants when possible.

The post is for 12 months with the possibility of extending if appropriate following appraisal. Educational appraisal is carried out by Mr Osman Farah-Functional service lead/program director fellowship and Mrs D. Bhargava Consultant Functional neurosurgeon.

The Functional team includes 2 Consultants, 2 Clinical fellow, 1 Specialist registrars,1 Research fellow 4 Specialist Nurses (Neuromodulation and Movement Disorders), 2 physiotherapist and 1 OT. The Functional fellow will participate in the MDT in the different areas of the functional service (Pain, Movement Disorders, Epilepsy) and will cover Mrs D. Bhargava and Mr Osman Farah clinics. Other Specialist functional clinics covered by the fellow include Pump/spasticity clinic, neuromodulation clinic and DBS/movement disorder clinic. The functional fellow will also co-ordinate the weekly Audit meeting keeping a registry of the weekly admissions (including morbidity and mortality). The functional service has 2 operating days (Monday and Wednesday) with 2 full day operating list per day. the fellow will actively participate in these lists in conjunction with other members of the team. The Fellow in functional neurosurgery will be encouraged to participate to the Educational activities of the firm (audit projects, presentation at international congresses etc).

Facilities for Functional Neurosurgery

The Walton Centre has excellent facilities for Functional Neurosurgery and has a large workload in surgery for Epilepsy, Chronic Pain (including Trigeminal neuralgia), Movement Disorders, Spasticity and resection in eloquent area. There are close working relationships with the Departments of Neurology, Neurophysiology, Neuropsychology and the Chronic Pain Service. There are multidisciplinary teams in each of these areas.

Epilepsy Surgery

There is an active epilepsy surgery programme that attracts patients from a wide area. A large number of resective surgical operations are undertaken as well as invasive monitoring procedures and Vagal nerve stimulation

Intra-operative and chronic recordings are routinely carried out using both depth and surface electrodes. Neurophysiological support for intra operative mapping is available.

There are five well equipped video telemetry rooms where scalp and intracranial recordings are routinely undertaken.

Service for SEEG and high definition EEG integrated with MRI have been started.

Pre-operative imaging is undertaken by the Magnetic Resonance Image Analysis and Research Centre of the University of Liverpool where there are excellent research facilities under the direction of the Professor of Imaging Science. Functional MRI is undertaken at the Walton Centre using a 3 Tesla GE Neuro-optimised scanner and a 3T Phillips scanner as well as DTI with facility to integrate advance imaging for surgical resection.

iMRI 3T Siemens is also available for epilepsy resections.

The Department of Neurology has a large epilepsy service provided by four consultants including the Professor of Neurology and this is further supported by the academic department of neuropsychology. The Clinical Trials Unit carries out a number of epilepsy drug trials.

There are monthly multi-disciplinary meetings for epilepsy surgery where investigations are systematically reviewed and clinical management is decided as well as planning meeting for invasive recordings.

Surgery for Chronic Pain

There is a long established Chronic Pain Service and. this includes a very busy surgical programme. There are five Consultant Pain Clinicians including the Professor of Pain Science and they work closely with the neurosurgeons to provide the Chronic Pain Surgery service. A monthly combined clinic is held for multi-disciplinary assessment of patients being considered for surgery for complex pain problems. There is a weekly clinical research and education meeting that is attended by a large number of clinicians. In addition the Pain Research Institute holds regular research and journal club meetings.

A wide range of percutaneous and open surgical procedures are undertaken for chronic pain conditions. The Centre has one of the largest neurostimulation programmes in the country including both spinal and intracranial stimulation. A number of intra-thecal infusion devices are also implanted for spasticity and chronic pain. A fortnightly multi-disciplinary neuromodulation clinic provides the post operative care for patients with implanted devices.

The investigation and management of facial pain including trigeminal neuralgia is of particular interest to the department; with a very active service providing percutaneous procedures, Microvascular decompression, and SRS (although currently not commissioned).

Cancer pain is an integral part of our Pain service with a joint service with pain clinician, palliative care consultants and neurosurgeons. Ablative procedures (either open or percutaneous) alongside intra-thecal therapy are part of the cancer pain service.

The Liverpool Pain Research Institute is part of the University Department of Neurosciences and has research and library facilities. The Institute also holds regular educational meetings. The Liverpool Pain Course is held annually and deals with various aspects of the management of chronic pain; there are also annual cancer pain meeting (nationally and internationally).

Surgery for Movement Disorders

A large number of surgical procedures for movement disorders are routinely carried out including deep brain stimulation, lesioning (thalamotomy) and surgery for hemifacial spasm.

There are a current plan to bring tcMRgUS to complement our movement disorder sevice.

The Centre has advanced facilities for stereotactic surgery including a stereotactic robot with planning software, stereotatic frames and frameless system. Neurophysiological monitoring with microelectrode recordings is regularly undertaken during surgery for movement disorders.

There are seven Consultant Neurologists with a sub-specialist interest in movement disorders and five of them with an interest in deep brain stimulation (DBS) providing the neurological support for the movement disorder surgery programme.

An integrated multi-disciplinary team runs the movement disorder surgery programme and includes neurosurgeons neurologists, neurophysiologists, neuropsychologists and movement disorder surgery specialist nurses/physiotherapist and OT. Additional support is obtained from operating theatre nurses and the neuroimaging specialists. Combined clinics with the neurologists are undertaken for the pre and post-operative assessment of these patients.

Surgery for Spasticity (Neuro-restoration)

The Walton centre spasticity service is a multidisciplinary service run jointly by neurosurgery, neuro-rehabilitation and neurology. This is the largest service in the North of England; procedures offered include intrathecal drug delivery, selective dorsal rhizotomy and peripheral neurectomy. There is a close relationship with the neurophysiology dept. for intra-operative neurophysiological monitoring and there are plan to develop a gait analysis lab to complement the service.

In conjunction with the spasticity service there is a newly developed neuro-restoration service; sacral stimulation for bladder incontinence, diaphragm stimulation for ventilation etc.

Resection in eloquent areas (epilepsy oncology and vascular)

There is a very active service of resection of brain lesion in eloquent area for epilepsy and oncological indications. This include awake craniotomies, resection with motor mapping and insersion of grid strips and depth for mapping prior resection.

This service is integrated with the neurophysiological serviced, the oncology service and epilepsy service. A total of 30-40 resection in eloquent area per year are carried out for a variety of indications including brainstem cavernoma.

Research

There is ample opportunity to undertake research projects during the term of the post and the clinical fellow will be expected to be involved in several research projects. Facilities for laboratory based research are available at the University of Liverpool and on site at the Clinical Sciences Centre.

Experience

Essential

• Basic surgical training must be
• completed as required by
• the Royal Colleges or approved
• overseas equivalent.
• Year 5-6 post CCT or equivalent
• Equivalent overseas training will
• be considered.

Desirable

• Intercollegiate examination
• in Neurosurgery.
• Some experience in functional neurosurgery

Personality

Essential

• Trustworthy, reliable, caring attitude and initiative.
• Cope with pressure.
• Able to take responsibility.
• Good communication.
• Ability to work as part of a team

Desirable

• Outside interests

Research

Desirable

• Some experience
• Publications
• Presentations

Qualifications

Essential

• MBCh or equivalent
• GMC registered
• FRCS or after 1998 MRCS/AFRCS
• (or approved overseas equivalent)

Desirable

• Higher or other degree
• Awards, distinctions, prizes, scholarships

Knowledge/ Clinical & Technical Skills

Essential

• Appropriate to experience with evidence of understanding
• and the ability to apply it in clinical practice.
• Competent in managing patients including note keeping, and in undertaking surgical procedures.
• Physically able to participate in long neurosurgical procedures
• Evidence of potential to develop.

Desirable

• Some experience in functional neurosurgery

Audit

Essential

• Understanding of principles

Desirable

• Participation in audit

Motivation

Essential

• Commitment to gaining sufficient
• experience and training
• to develop a sub-specialist interest in functional neurosurgery.

Desirable

• Critical enquiring approach to
• acquisition of knowledge

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).