Neurosciences - Managed Service Network Neurosurgery

The Department of Clinical Neurosciences, Western General Hospital
The term 'neuroscience' refers to a group of specialist disciplines. The two main specialties
are neurology (medical) and neurosurgery (surgical). Along with a range of other specialists,
neurologists and neurosurgeons treat people with disorders of the nervous system. These
include problems affecting the brain and spinal cord and the nerves and muscles in the rest of
the body, such as multiple sclerosis, Parkinson’s disease, or brain injuries.
Disorders of the nervous system are quite common. Not all are serious and many can be
dealt with locally by your GP and in the community. Some people will need to be referred to a
secondary care facility, like a local hospital. Some people, who need more specialist care, will
have to go to a neuroscience centre.
The neuroscience centre here in Edinburgh is not only for the people of Lothian, it is where
patients from the Borders, Dumfries & Galloway, Forth Valley and Fife are transferred for
specialist care. It covers a population of 1.6 million across these areas, while for some
specialist services it covers the 2.8 million people living on the east side of Scotland.
NHS Lothian’s Department of Clinical Neuroscience is currently located at the Western
General Hospital in North West Edinburgh.
The department has three wards (49 beds and 7 high dependency beds), 2 operating
theatres, diagnostic services (e.g. scans) and an outpatients department. The department
also provides a 6 patient day case area for programmed investigations (PIU) and all elective
patients are pre-admitted through the pre-assessment service.
An outpatient service is also provided at St John’s Hospital in Livingston, The Conan Doyle
GP Practice, Edinburgh, Roodlands Hospital, Haddington Hospital and the Royal Infirmary of
Edinburgh. The service for children is provided in the Royal Hospital for Sick Children in
Surgical Directory
The department has seven neurosurgeons. They are:Mr Patrick Statham
Mr Michael Fitzpatrick (Clinical Director)
Mr Anant Kamat (Locum)
Mr Ioannis Fouyas
Miss Lynn Myles
Mr Jerard Ross
Mr Jegajothy Kandasamy
All surgeons carry out cranial and spinal surgery but have developed specialist interests: Mr
Patrick Statham in pituitary/skull base and complex spinal surgery; Mr Michael Fitzpatrick in
trigeminal neuralgia; Mr Jerard Ross in paediatric neurosurgery and epilepsy surgery; Mr
Ioannis Fouyas in vascular and skull surgery; Mr Jothy Kanadsamy in paediatric surgery and
Miss Lynn Myles in peripheral nerve surgery. The surgeons also have clinical responsibility
for the patients who have been admitted and treated for a sub-arachnoid haemorrhage (SAH).
Close links with Interventional Neuroradiology, Medical Neurology and Oncology have been
established with neuro-oncological and neurointerventional multidisciplinary teams coordinating the management of patients with cerebrovascular pathologies and brain tumours.
Patients from the entire East of Scotland, needing endovascular treatment are transferred to
Edinburgh. Historical links with otolaryngologists, plastic surgeons, orthopaedic spinal
surgeons and maxillofacial surgeons have been established, and combined procedures are
frequently performed in patients with either complex pathologies or acute trauma. Team
working with medical epileptologists is also pursued for the treatment of patients with
intractable epilepsy.
The service provides an elective service for surgery and also provides a 24 hour emergency
receiving service as it is a tertiary receiving centre. Some facts about our service
All emergencies are referred via the referral process from their local emergency
departments/hospitals. It is aimed to admit these referrals to the department within
48 hours of referral.
The average length of stay is 3-10 days.
All patients who require a follow-up should have an out-patient appointment in 4
months from surgery.
Brain tumour patients are followed up by the Edinburgh Centre for Neuro-oncology
The SAH patients are followed up by Clinical Nurse Specialist in 3 months from
Patients are assessed as in-patients to assess if further input is required e.g. rehabilitation or
discharge home with support. This assessment is carried out by members of the multidisciplinary team (MDT). The department has close working links with external services that
provide this assistance in rehabilitation and also with the hospital-based social work team if
the support is required in the community.
The main services used are:Service Name
Astley Ainslie Hospital
Lead/Referral Process
Dr Smith/Dr Fitzgerald
Falkirk Community
Dr Premphie
Edinburgh Community
(community rehabilitation
and brain injury service)
National Spinal Unit
Via social service
Refer via on call
Medicine of the Elderly
Local District Hospitals
Referred through NHS
Lothian referral policy.
Refer to on call medical
Contact Information
133 Grange Loan, Edinburgh,
EH9 2HL.
0131 535 9000
Unit 1, Falkirk Community
FK1 5QE.
01324 624 000
Slateford Physiotherapy Clinic,
Slateford Medical Practice,
EH14 1NQ.
0131 442 8700
The Queen Elizabeth National
Spinal Injuries Unit, Southern
General Hospital, 1345 Govan
G51 4TF.
0141 201 2555
Various sites across Lothian
Various sites
The department has links with support services/organisations that are available to patients.
The departments Clinical Nurse Practitioners (CNP) work close with patients/relatives/carers
in making sure the care provided is fully holistic and access these services if required.
The main organisations are:-
Support Service/Organisation
ECNO (Edinburgh Centre for NeuroOncology)
British Brain Tumor Society
Brain & Spine foundation
Clic Sargent
Contact information
Shanne McNamara, Specialist Nurse in
Neuro-Oncology. (Based local).
Headway House, Astley Ainslie
Hospital, Cannan Lane,
Edinburgh, EH9 2HL.
0131 446 9681
The future of Clinical Neuroscience in Lothian
The Department of Clinical Neuroscience at the Western General Hospital building was
purpose-built in the 1960s, but it is no longer flexible enough to accommodate everything we
would want to do. It is too small for the number of patients we see and treat and cannot be
adapted to accommodate the specialist procedures and technologies in use today. NHS
Lothian looks forward to providing accommodation that will support these specialties in
staying at the forefront of neuroscience patient care.
The Department only sees adult patients, but some of its highly specialist staff work in the
children’s service as well, currently on a different hospital site. However, a new Royal Hospital
for Sick Children, beside the Royal Infirmary of Edinburgh at Little France, is being planned
for 2017. NHS Lothian would like to take this opportunity to improve how we efficiently we
treat patients by delivering adult and children’s neuroscience services on the same site.
Joint working between the Department and the University of Edinburgh to provide clinical
care, state-of-the-art equipment, teaching and research, benefits both patients and staff and
contributes to the Department’s status as a leader in its field. The University plans to expand
its research interests with the building of an Institute of Neurosciences at Little France. Being
nearby would ensure continuing benefits to patients.
Many of the reasons for change suggest that clinical neurosciences should be located
alongside the Royal Infirmary of Edinburgh’s Emergency Department and the Royal Hospital
for Sick Children. The process to review all options for the site of the Department of Clinical
Neuroscience in future has been carried out in partnership with all groups who have an
interest, including patient and public representatives. To address the challenges above NHS
Lothian have recommended that the future home of clinical neurosciences be at Little France.