Martin Tisdall – Paediatric Neurosurgery Fellowship report

In September 2012 I left London to take up a fellowship in paediatric neurosurgery at the Hospital for Sick Children in Toronto, Canada. Sick Kids, is one of the premier paediatric neurosurgery departments worldwide and a significant proportion of international paediatric neurosurgeons have passed through their training program.

I arrived to find Toronto bathed in glorious sunshine: a surprise given the stories I had heard of arctic winters and deep snow. I spent a year at Sick Kids developing my knowledge and skills. The fellowship covered all aspects of paediatric neurosurgery including elective and emergency cases, and inpatient and outpatient care. I have a particular interest in the surgical management of paediatric epilepsy and the exceptional strength of Sick Kid’s epilepsy surgery program was one of the attractions of the fellowship.

I have gained experience in all aspects of the management of epilepsy surgery patients, taking them from pre-operative consultation and work-up through the operative phase and then into post-operative follow up. Sick Kids has pioneered the use of magneto-encephalography (MEG) in children as a technique to non-invasively identify seizure foci. A MEG scanner is essentially an extremely powerful detector of magnetic fields able to detect synchronized neuronal currents and thus identify epileptic foci. At Sick Kids, all patients considered for epilepsy surgery undergo MEG as part of their workup and the team has therefore built up a large experience. Whilst MEG is available in the UK, it is not used routinely and so I learnt a lot from seeing how the epilepsy surgery MDT used MEG data to aid surgical decision making. A significant number of the surgical candidates underwent initial placement of invasive grid and depth electrodes in order to more fully characterize the seizure onset zone prior to respective surgery. I was able to spend considerable time with the neurophysiology team learning about the analysis of both scalp EEG and invasive EEG. In particular I learnt cutting edge techniques used to identify high frequency oscillations in the invasive EEG signals and then plan the surgical resection.

It has been hugely beneficial to me to meet and work with a group of paediatric neurosurgeons who have trained in a different healthcare system to my own. This has given a new breadth to my neurosurgical training and has taught me that there are many ways to approach the same neurosurgical problem. I have also been able to build up a network of international colleagues, both staff and trainees, with whom I hope to stay in contact over the coming years.

I travelled to Toronto with my wife and two year old daughter. We all loved Toronto and have had great time exploring this friendly and diverse city. We have all made many Canadian friends and I hope that we will be able to stay in touch over the years. Despite the subzero temperatures, the winter was a fun time to be in Canada and we were able to introduce my daughter to tobogganing and skiing.

I am returning to the UK to take up a consultant post at Great Ormond Street Hospital with a subspecialty interest in paediatric epilepsy surgery. The techniques I have learnt at Sick Kids will be immensely useful in my new job. The award I received has been incredibly helpful in coping with the financial burden of my fellowship and I am extremely indebted for the assistance it has provided.

I would highly recommend the Sick Kids fellowship to any aspiring paediatric neurosurgeon.