Fellowship in Functional Neurosurgery and Complex Epilepsy

Fellowship in Functional Neurosurgery and Complex EpilepsyApplications are invited from suitably qualified doctors for the above post, to start from September 2024.This is a post that offers one year training in Functional Neurosurgery including Surgery for Movement Disorders, Complex Epilepsy, Chronic Pain, Spasticity and resection in eloquent areas. The post will be suitable for trainees nearing completion of their neurosurgical training and seeking to develop a sub-specialist interest in Functional Neurosurgery and complex epilepsy.The successful candidate will have a commitment to the on-call rota. This post is RCSEng Senior Clinical fellowship scheme recognised.The fellows will be encouraged to be on call with the 2 functional Consultants when possible.The post is initially for 12 months with the possibility of extending if appropriate following appraisal.Further information regarding the post can also be obtained by contacting:- Mr Osman Farah, Consultant Neurosurgeon-Functional lead, tel 0151 529 5681 or email ##### duties of the jobThis post will all aspects of functional neurosurgery (epilepsy, pain, spasticity movement disorders and resection in eloquent area). This fellowship post will participate in the neurosurgical specialist registrar on-call rota. The Trust currently has a 2 tier system for the on-call, the 1st tier are the ST3 to ST6 and the 2nd on-call the more senior trainees or post CCT Fellows. 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 Functional team includes 2 Consultants, 2 Clinical fellow, 1 Specialist registrars,1 Research fellow, 4 Specialist Nurses, 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. This Fellow will be encouraged to participate to the Educational activities of the firm.About usThe Walton CentreNHS Foundation Trust is the only NHS trust to hold dual accreditation for theInvestors in People we invest in people and we invest in wellbeingstandards and has been awarded Gold status for both. TheWalton Centre is a leader in the treatment and care of neurology andneurosurgery, placing the patient and their family at the heart of everythingwe do. As the only specialist hospital trust in the UK dedicated to providingcomprehensive neurology, neurosurgery, spinal and pain management services weare proud to be rated as an Outstanding Trust by the Care Quality Commission(CQC), and champion change throughout the field of neuroscience. Originallyformed in 1992, the Trust received Foundation Trust status in 2009.Witharound 1,450 staff, The Walton Centre treats more than 127,000 outpatients and18,000 inpatients each year. We have leading specialists and incrediblydedicated staff delivering excellent clinical outcomes for brain, spinal andneurological care nationally and internationally. Teams across our site inFazakerley, Liverpool, offer a world-class service in diagnosing and treatinginjuries and illnesses affecting the brain, spine and peripheral nerves andmuscles, and in supporting people suffering from a wide range of long-termneurological conditions.Job responsibilitiesThePostThispost is intended to provide service cover in all aspects of functionalneurosurgery (epilepsy, pain, spasticity movement disorders and resection ineloquent area). The fellow in Functional Neurosurgery will participate in theneurosurgical specialist registrar on-call rota. The Trust currentlyhas a 2 tier system for the on-call, the 1st on-call are the morejunior trainees and the 2nd on-call the more senior trainees. Theamount of time dedicated to the functional syllabus will depend on the tier oncall 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 thefirst tier then these figures are 40% and 60%. If the applicant has a completedCCT then he/she can expect to be on the second tier, but this will be assessedby the Clinical Director following appointment.Thefellows will be encouraged to be on call with the 2 functional Consultants whenpossible.Thepost is for 12 months with the possibility of extending if appropriate followingappraisal. Educational appraisal is carried out by Mr Osman Farah-Functionalservice lead/program director fellowship and Mrs D. Bhargava ConsultantFunctional neurosurgeon.TheFunctional team includes 2 Consultants, 2 Clinical fellow, 1 Specialistregistrars,1 Research fellow 4 Specialist Nurses (Neuromodulation and MovementDisorders), 2 physiotherapist and 1 OT. The Functional fellow will participate inthe MDT in the different areas of the functional service (Pain, MovementDisorders, Epilepsy) and will cover Mrs D. Bhargava and Mr Osman Farah clinics.Other Specialist functional clinicscovered by the fellow includePump/spasticity clinic, neuromodulation clinic and DBS/movement disorderclinic. The functional fellow will alsoco-ordinate the weekly Audit meeting keeping a registry of the weeklyadmissions (including morbidity and mortality).The functional service has 2 operating days (Monday and Wednesday) with2 full day operating list per day. the fellow will actively participate in theselists in conjunction with other members of the team. The Fellow in functional neurosurgery will beencouraged to participate to the Educational activities of the firm (auditprojects, presentation at international congresses etc).Facilities for Functional Neurosurgery Job descriptionJob responsibilitiesThePostThispost is intended to provide service cover in all aspects of functionalneurosurgery (epilepsy, pain, spasticity movement disorders and resection ineloquent area). The fellow in Functional Neurosurgery will participate in theneurosurgical specialist registrar on-call rota. The Trust currentlyhas a 2 tier system for the on-call, the 1st on-call are the morejunior trainees and the 2nd on-call the more senior trainees. Theamount of time dedicated to the functional syllabus will depend on the tier oncall 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 thefirst tier then these figures are 40% and 60%. If the applicant has a completedCCT then he/she can expect to be on the second tier, but this will be assessedby the Clinical Director following appointment.Thefellows will be encouraged to be on call with the 2 functional Consultants whenpossible.Thepost is for 12 months with the possibility of extending if appropriate followingappraisal. Educational appraisal is carried out by Mr Osman Farah-Functionalservice lead/program director fellowship and Mrs D. Bhargava ConsultantFunctional neurosurgeon.TheFunctional team includes 2 Consultants, 2 Clinical fellow, 1 Specialistregistrars,1 Research fellow 4 Specialist Nurses (Neuromodulation and MovementDisorders), 2 physiotherapist and 1 OT. The Functional fellow will participate inthe MDT in the different areas of the functional service (Pain, MovementDisorders, Epilepsy) and will cover Mrs D. Bhargava and Mr Osman Farah clinics.Other Specialist functional clinicscovered by the fellow includePump/spasticity clinic, neuromodulation clinic and DBS/movement disorderclinic. The functional fellow will alsoco-ordinate the weekly Audit meeting keeping a registry of the weeklyadmissions (including morbidity and mortality).The functional service has 2 operating days (Monday and Wednesday) with2 full day operating list per day. the fellow will actively participate in theselists in conjunction with other members of the team. The Fellow in functional neurosurgery will beencouraged to participate to the Educational activities of the firm (auditprojects, presentation at international congresses etc).Facilities for Functional NeurosurgeryTheWalton Centre has excellent facilities for Functional Neurosurgery and has alarge workload in surgery for Epilepsy, Chronic Pain (including Trigeminalneuralgia), 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 aremultidisciplinary teams in each of these areas.EpilepsySurgeryThereis an active epilepsy surgery programme that attracts patients from a widearea. A large number of resective surgical operations are undertaken as well asinvasive monitoring procedures and Vagal nerve stimulationIntra-operativeand chronic recordings are routinely carried out using both depth and surfaceelectrodes. Neurophysiological support for intra operative mapping isavailable.Thereare five well equipped video telemetry rooms where scalp and intracranialrecordings are routinely undertaken.Servicefor SEEG and high definition EEG integrated with MRI have been started.Pre-operativeimaging is undertaken by the Magnetic Resonance Image Analysis and ResearchCentre of the University of Liverpool where there are excellent researchfacilities under the direction of the Professor of Imaging Science. Functional MRI isundertaken at the Walton Centre using a 3 Tesla GE Neuro-optimised scanner anda 3T Phillips scanner as well as DTI with facility to integrate advance imagingfor surgical resection.iMRI3T Siemens is also available for epilepsy resections.TheDepartment of Neurology has a large epilepsy service provided by fourconsultants including the Professor of Neurology and this is further supportedby the academic department of neuropsychology. The Clinical Trials Unit carriesout a number of epilepsy drug trials.Thereare monthly multi-disciplinary meetings for epilepsy surgery whereinvestigations are systematically reviewed and clinical management is decidedas well as planning meeting for invasive recordings.Surgery for Chronic PainThereis a long established Chronic Pain Service and. this includes a very busysurgical programme. There are five Consultant Pain Clinicians including theProfessor 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 forcomplex pain problems. There is a weekly clinical research and educationmeeting that is attended by a large number of clinicians. In addition the PainResearch Institute holds regular research and journal club meetings.Awide range of percutaneous and open surgical procedures are undertaken forchronic pain conditions. The Centre has one of the largest neurostimulationprogrammes in the country including both spinal and intracranial stimulation. Anumber of intra-thecal infusion devices are also implanted for spasticity andchronic pain. A fortnightly multi-disciplinary neuromodulation clinic providesthe post operative care for patients with implanted devices.Theinvestigation and management of facial pain including trigeminal neuralgia isof particular interest to the department; with a very active service providingpercutaneous procedures, Microvascular decompression, and SRS (althoughcurrently not commissioned).Cancerpain is an integral part of our Pain service with a joint service with painclinician, palliative care consultants and neurosurgeons. Ablative procedures(either open or percutaneous) alongside intra-thecal therapy are part of thecancer pain service.TheLiverpool Pain Research Institute is part of the University Department ofNeurosciences and has research and library facilities. The Institute also holdsregular educational meetings. The Liverpool Pain Course is held annually and dealswith various aspects of the management of chronic pain; there are also annualcancer pain meeting (nationally and internationally).Surgery for Movement DisordersA large number of surgical procedures for movement disorders areroutinely carried out including deep brain stimulation, lesioning (thalamotomy)and surgery for hemifacial spasm.There are a current plan to bring tcMRgUS to complement our movementdisorder sevice.The Centre has advanced facilities for stereotactic surgery including astereotactic robot with planning software, stereotatic frames and framelesssystem. Neurophysiological monitoring with microelectrode recordings is regularlyundertaken during surgery for movement disorders.There are seven Consultant Neurologists with a sub-specialist interestin movement disorders and five of them with an interest in deep brainstimulation (DBS) providing the neurological support for the movement disordersurgery programme.An integrated multi-disciplinary team runs the movement disorder surgeryprogramme and includes neurosurgeons neurologists, neurophysiologists,neuropsychologists and movement disorder surgery specialist nurses/physiotherapistand OT. Additional support is obtained from operating theatre nurses and theneuroimaging specialists. Combined clinics with the neurologists are undertakenfor the pre and post-operative assessment of these patients.Surgery for Spasticity (Neuro-restoration)The Walton centre spasticity service is a multidisciplinary service runjointly by neurosurgery, neuro-rehabilitation and neurology. This is thelargest service in the North of England; procedures offered include intrathecaldrug delivery, selective dorsal rhizotomy and peripheral neurectomy. There is aclose relationship with the neurophysiology dept. for intra-operativeneurophysiological monitoring and there are plan to develop a gait analysis labto complement the service.In conjunction with the spasticity service there is a newly developedneuro-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 eloquentarea for epilepsy and oncological indications. This include awake craniotomies,resection with motor mapping and insersion of grid strips and depth for mappingprior resection.This service is integrated with the neurophysiological serviced, theoncology service and epilepsy service. A total of 30-40 resection in eloquentarea per year are carried out for a variety of indications including brainstemcavernoma.ResearchThere is ample opportunity to undertake research projects during theterm of the post and the clinical fellow will be expected to be involved inseveral research projects. Facilities for laboratory based research areavailable at the University of Liverpool and on site at the Clinical SciencesCentre. Person SpecificationExperienceBasic surgical training must becompleted as required bythe Royal Colleges or approvedYear 5-6 post CCT or equivalentEquivalent overseas training willbe considered.Some experience in functional neurosurgeryPersonalityTrustworthy, reliable, caring attitude and initiative.Cope with pressure.Able to take responsibility.Good communication.Ability to work as part of a teamResearchPublicationsPresentationsQualificationsMBCh or equivalentGMC registeredFRCS or after 1998 MRCS/AFRCS(or approved overseas equivalent)Higher or other degreeAwards, distinctions, prizes, scholarshipsKnowledge/ Clinical & Technical SkillsAppropriate to experience with evidence of understandingand 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 proceduresEvidence of potential to develop.Some experience in functional neurosurgeryAuditUnderstanding of principlesParticipation in auditMotivationCommitment to gaining sufficientexperience and trainingCritical enquiring approach toacquisition of knowledgeDisclosure and Barring Service CheckThis 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.
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