From the invention of insulin, to the creation of the very first MRI scanner, Aberdeen has a proud history of producing medical firsts.
Now a doctor at Aberdeen Royal Infirmary looks set to write his name the North-east’s rich research lineage with a “game-changing” new surgical technique.
Neurosurgeon Anastasios Giamouriadis has pioneered a new form of keyhole brain surgery that can have patients back at work within a month of going under the knife.
Anastasios Giamouriadis moved from London to Aberdeen in 2019, just a fortnight before becoming a father. Shortly after, he developed and created minimally invasive brain tumour surgery, a potentially life-changing and life-saving operation for countless people in the North-east.
It removes large tumours from the front of the brain by making keyhole incisions through the eyebrow.
Rather than spending weeks in hospital, including time in intensive care, the new surgery will have patients home within 48 hours.
“For very large tumours, especially in the frontal area, the traditional access is normally a very large cut. From one ear to the other, or from one ear to the top of the head,” Anastasios explained.
“You do extensive craniotomy in order to remove a very large brain tumour. That’s the standard approach and it’s a very lengthy operation. The brain is exposed for many hours, it’s quite morbid and there are a lot of risks.
“Patients go into intensive care for a few days, at least, then they spend lots of time on the ward and many times a year they can end up in rehab. They are back home, probably, after six or nine months, or even a year.
“What I do is I remove these tumours through a keyhole approach through the eyebrow.
“That approach has been established for a long time in neurosurgery all around the world, but only for small tumours.”
With the new approach, that has been formally acknowledged by neurosurgeons across Europe, Anastasios has been able to cut recovery time to a fraction of what it was for patients in the North-east.
“I have modified the standard eyebrow approach and I’m able to remove very large tumours through the eyebrow. The big difference is that patients go home on the second day.
“It’s still very complex and it’s even more technically challenging than having a very big craniotomy, but patients are back home on the second day with a swollen eye which goes back to normal after a few days.
“The scar is barely visible after a few weeks or months. They are back to normal life very quickly.
“It’s a game-changer for patient outcome but it also has a very significant socio-economic impact.
“We save a lot of money for the NHS. No intensive care and no rehab. Essentially, it’s just two nights in the hospital and patients go back to their everyday lives very quickly.
“Within two to four weeks, maximum, patients can go back to their job.
“With this surgery, which is technically more challenging, there is no other way you can get a patient back to normal so quickly.
“Minimal invasive surgery is the future for any surgery in any part of the body, but especially in the brain, it makes a huge difference for patient outcomes, it’s a huge step forward.
“Every Thursday for the next two months I’m doing another surgery, we’ve done 40 already and we haven’t had any major problems directly related with the minimal invasive approach.”
Exposing the brain for less time and making a smaller incision has a number of patient benefits.
The keyhole approach allows Anastasios to focus in on the tumour in a fraction of the time that that it would take during the standard approach.
“I started by thinking that we have exposed a lot of brain to begin with. That, on its own, without any other problems, will delay the recovery of the patient,” added the 43-year-old.
“Through minimal invasion brain tumour surgery, we expose as little brain as possible. That makes a big difference.
“With big operations, you spend about a couple of hours just to get to the tumour. With my approach, I’m on the tumour within 20 minutes. This way, we minimise complications.”
Despite what is usually a lengthy operation, the final moments of removing the tumour generally prove to be the most difficult.
Removing the last part, which is stuck on to tiny vessels and nerves, can have a devastating impact on the patient.
“If anything goes wrong, best case scenario, you’re looking at a massive stroke. If not, then death,” added Anastasios.
That was the turning point for the Athens-born neurosurgeon.
“It drove me to think: ‘we are doing something wrong here’.
“These patients, with big tumours at the front of their head, develop cognitive impairment, mobility impairment and significant visual impairment, so they can go blind.
“If you are operating on a large tumour the normal way, you’re operating for 8-10 hours.
“With this operation, we’ve stopped them from further deterioration and, in most cases, they have gained back normal vision. So, patients can be back driving after a few months, which is crucial for them.”
Within a year of moving to Aberdeen, the first patient went in for minimal invasive brain tumour surgery in the summer of 2020, less than a year after Anastasios began working on the new approach.
“CV19 pushed me further to do this. We didn’t have theatre, we didn’t have beds, we didn’t have staff. But people were still going blind or dying from these large brain tumours.
“So, I had to sort them out. CV19 was another good reason to get them in, expose as less people as possible to any CV19 risk, and get them back home as soon as possible, rather than catching CV19 in hospital.”
And he’s now presenting his work across the continent.
In September, Anastasios presented his work to the European Congress of Neurosurgery in Barcelona after doing the same to the Society of British Neurological Surgeons earlier in the month.
“Our series has been well recognised and acknowledged as one of the most pioneering, at least in Europe.”
Anastasios is now a Consultant Neurosurgeon at NHS Grampian, Honourary Senior Clinical Lecturer at Aberdeen University and the Lead Minimally Invasive, Skull Base and Pituitary Surgeon for the North of Scotland Brain and Spine Centre.
Born in Greece, he moved to London in 2010 where he stayed for six years before moving to New York where he became a Fellow in Minimally Invasive Brain Surgery. He moved back the UK’s capital a year later before finding his home in the Granite City.
He says moving north to start his family was a “no-brainer” after seeing the city.
“I moved to Aberdeen for quality of life. It came out of nowhere, but my wife was approaching 36 weeks pregnant.
“The lifestyle in London is very different and it’s not family friendly under any circumstance. I was seeing friends and family who were a step ahead of me with young kids and it was quite hard, I could see they were struggling.
“I travelled up here thrice before my interview and I was trying to find something wrong, and I couldn’t. I was going back home to my wife and saying ‘it’s a no-brainer’.
“It’s the best thing we ever did. There’s a great community, it’s multi-national, it’s progressive, it’s been through challenges, but I think it’s a rising area again now.
“My job is very demanding but here I have quality of time for my family, otherwise they would never see me.
“We drove up here from London 37 weeks pregnant. I worked for two weeks exactly (when the baby was born), and I didn’t take my parental leave.
“In the UK, generally, the healthcare training in the NHS is fantastic. You don’t get that load or quality of training anywhere else. I fully respect that I owe the NHS everything and that’s why I’m dedicating my work to the NHS.”