Question 1

How do I book a consultation with Dr Human?

Accepted Answer

Use the Request appointment button in the header or the Contact page. Submit your name, contact details and a brief description of your symptoms. My rooms will respond within one business day to confirm a time.

Question 2

Do I need a referral from my GP?

Accepted Answer

No — you can book directly. That said, a referral letter and any relevant imaging make the first appointment much more productive, and some medical aids reimburse specialist visits better when they are referred.

Question 3

What should I bring to the first appointment?

Accepted Answer

Bring your ID, medical aid card, any imaging on disc (MRI, CT), the imaging reports, a list of current medications and supplements, and — if you have them — previous operation notes and blood results.

Question 4

Do you accept medical aid?

Accepted Answer

Yes. The practice works with all major South African medical aids. My rooms will obtain pre-authorisation for any planned procedure and give you a written quote before you commit, so any co-payment is known in advance.

Question 5

How long is the first consultation?

Accepted Answer

Plan for 30 to 45 minutes. This covers a full history, a focused neurological examination, review of your imaging together, and a clear written plan by the end.

Question 6

Where are your rooms?

Accepted Answer

The main practice is based at Life Wilgeheuwel Hospital in Roodepoort, Johannesburg. Full address and directions are on the Contact page.

Question 7

What should I expect at my first neurosurgeon appointment?

Accepted Answer

The first appointment usually takes 30 to 45 minutes. It is a conversation before it is anything else: I want to hear your story in your own words — when the symptoms started, what makes them better or worse, and how they are affecting your daily life. After that I will do a focused neurological examination. This looks at strength, reflexes, sensation, coordination and — where relevant — cranial nerve function. It is painless and takes only a few minutes. We will then review any scans you have brought, side by side, on a large screen. I will explain what the images show in plain language and, importantly, what they do not show. A finding on an MRI is only meaningful when it matches your symptoms and examination. By the end of the consultation you should leave with three things: a clear working diagnosis, a written plan (whether that is more investigations, conservative treatment, or surgery), and honest answers to the questions that matter most to you. You are welcome to bring a partner or family member. Two sets of ears are better than one, and some of the information is easier to process afterwards with someone you trust.

Question 8

How do I prepare for brain surgery?

Accepted Answer

Once a surgical date is set, my rooms will send you a written preparation pack. It covers the hospital admission time, fasting instructions, what to pack and which medications to stop. In the weeks before surgery, focus on the things that improve outcomes: stop smoking, control blood pressure and blood sugar, and stay as active as your condition allows. If you drink alcohol regularly, tell me — sudden cessation can complicate the anaesthetic. About a week before, arrange practical support at home: someone to drive you home from hospital, help with children or elderly parents, and, if you live alone, a friend or family member for at least the first week of recovery. On admission day, bring your ID, medical aid card, authorisation letter, a list of all medications and supplements, your imaging on disc, comfortable loose clothing and toiletries. Leave valuables at home. The night before, follow the fasting instructions exactly — usually nothing to eat or drink from midnight. Shower with the antiseptic wash if you have been given one. Try to sleep. Everything you need to do has already been done.

Question 9

Do neurosurgeons remove brain tumours?

Accepted Answer

Brain tumour surgery is a central part of what neurosurgeons do. The goal of an operation depends on the type of tumour: for some it is a complete cure, for others it is to remove as much as safely possible, and for a few it is simply to obtain tissue for diagnosis. Not every brain tumour needs surgery. Small, slow-growing lesions in low-risk locations may be monitored with serial MRI. Others are better treated with radiation, chemotherapy, or a combination. The decision is always taken in a multidisciplinary meeting with oncology and radiology. When we do operate, modern tools make an enormous difference. Neuronavigation gives us a live map of the tumour and surrounding structures. Intraoperative monitoring warns us if we get too close to critical pathways. In selected cases we operate with the patient awake so we can protect speech and movement in real time. The overwhelming majority of patients wake up neurologically the same as they went to sleep — often better, once the pressure from the tumour is relieved. Recovery, risks and long-term outcomes depend heavily on tumour type, which we will discuss in detail before you consent.

Question 10

What conditions do neurosurgeons treat?

Accepted Answer

The nervous system is a single continuous organ, and neurosurgery covers all of it: the brain, the spinal cord, the spinal column and the peripheral nerves. On the cranial side, common conditions include brain tumours (both primary and metastatic), aneurysms and vascular malformations, chronic and acute subdural haematomas, hydrocephalus (treated with shunts or endoscopic third ventriculostomy), trigeminal neuralgia, and traumatic brain injury. On the spinal side, most patients present with nerve compression — a herniated lumbar or cervical disc pressing on a root, or spinal stenosis narrowing the canal in older patients. We also treat spinal tumours, fractures, deformity and instability requiring fusion. Peripheral nerve work includes carpal tunnel release, ulnar nerve decompression at the elbow, and nerve tumours such as schwannomas. Not every condition on this list needs surgery. Much of what a neurosurgeon does in consultation is to reassure patients that they do not need an operation and to guide them to the right non-surgical treatment.

Question 11

How long does neurosurgery recovery take?

Accepted Answer

For a straightforward lumbar microdiscectomy, most patients are home the next day, back to office work in two weeks, and back to physical work or gym at six weeks. For a cervical anterior discectomy and fusion (ACDF), expect one night in hospital, two to three weeks off work, and a soft collar for comfort in the first couple of weeks. For a craniotomy — whether for a tumour, aneurysm or subdural — plan for two to four nights in hospital, two to six weeks at home, and a graded return to full activity over three months. Driving is usually restricted for at least four weeks and longer if there have been seizures. For a lumbar fusion, the incision heals in three weeks but the bone takes three to six months to fuse. Light activity is fine early on; heavy lifting and impact sport must wait. Across all of these, the number one predictor of good recovery is you: not smoking, moving daily, eating well and following the physiotherapy plan. I will give you specific milestones at your first post-operative visit.

Question 12

Is brain surgery safe? What are the risks?

Accepted Answer

Brain surgery today is not what it was thirty years ago. Neuronavigation, intraoperative monitoring, high-magnification microscopes and refined anaesthesia have transformed outcomes. The majority of elective procedures are performed with very low rates of serious complication. That said, no operation is risk-free. General surgical risks include bleeding, infection, and complications of anaesthesia. Neurosurgery-specific risks include stroke, seizure, cerebrospinal fluid leak, and a neurological deficit related to the area operated on — weakness, speech disturbance or vision change. The size of these risks depends entirely on the operation and the patient. Removing a small meningioma at the surface of the brain in a healthy 45-year-old is a different conversation to operating on a deep-seated tumour near the speech area in someone with heart disease. Before every operation I will give you the specific numbers for your procedure — not generic percentages. You will hear the worst plausible outcome as well as the expected one, so your consent is genuinely informed. The most important risk to weigh is the risk of doing nothing. For many conditions, the natural course is worse than the operation. That comparison — surgery versus no surgery — is the one that actually matters.

Question 13

What questions should I ask my neurosurgeon?

Accepted Answer

The most useful question is the simplest: "What exactly is wrong with me, in plain language?" Ask me to draw it, show it on the MRI, or write it down. If you cannot repeat it back to a family member, we have not explained it well enough. Then ask about options: "What are all my choices, including doing nothing?" There is almost always more than one path. Understanding the full menu — surgery, injection, physiotherapy, medication, watchful waiting — makes the decision yours. Ask about outcomes with numbers: "What percentage of your patients with this condition improve significantly? What percentage have a serious complication?" A good answer is specific, not vague. Ask about experience: "How many of these operations do you personally do each year?" Volume matters in neurosurgery. It is a fair question and I will always answer it. Finally: "What will recovery actually look like, week by week?" and "What are the warning signs I should call you about after I go home?" These are the questions that matter most once the operation is over.

Question 14

How do I know if I need a neurosurgeon?

Accepted Answer

You do not have to be sent by another doctor to see me — many patients book directly — but a referral letter and any relevant scans make the first appointment much more productive. The clearest indication for a neurosurgical opinion is a scan showing a lesion that may need surgery: a brain tumour, an aneurysm, a large disc herniation, spinal stenosis with weakness, or hydrocephalus. The other clear indication is a set of symptoms that are getting worse despite conservative treatment: leg or arm weakness, loss of bladder or bowel control, worsening headaches with vomiting, new seizures, or progressive numbness. Persistent back or neck pain alone, without neurological symptoms, is usually managed first by a GP, physiotherapist or pain specialist. It becomes a neurosurgical question when nerve compression develops or when conservative treatment has genuinely failed after several months. If you are unsure, ask your GP or send my rooms a short summary and your scan report. We will tell you honestly whether a consultation is worthwhile.

Question 15

What's the difference between a neurologist and a neurosurgeon?

Accepted Answer

A neurologist is a physician: they diagnose and treat diseases of the brain, spinal cord and nerves using medication, lifestyle interventions and rehabilitation. Epilepsy, migraine, multiple sclerosis, Parkinson's disease, stroke prevention and peripheral neuropathies are largely their world. A neurosurgeon is a surgeon: we treat conditions where an operation is either the definitive treatment or one of the main options. Brain and spinal tumours, aneurysms, disc herniations, hydrocephalus and traumatic bleeds are largely ours. In practice we overlap constantly. A patient with new seizures might see a neurologist first for anti-epileptic medication, and then be referred to me if a tumour or vascular lesion is found on MRI. A patient with severe sciatica might see me first, and then be referred to a neurologist if the imaging is unremarkable but their symptoms suggest a neuropathy. If you are not sure which one to see, start with your GP. They can look at your symptoms and point you to the right specialist. Sending you to the wrong one first wastes time and money.

Question 16

Can neurosurgeons treat spine problems?

Accepted Answer

Yes — spinal surgery is a very large part of what I do. In South Africa, both neurosurgeons and orthopaedic spinal surgeons operate on the spine; the training paths differ but the operations overlap significantly. The most common spinal operations I perform are lumbar microdiscectomy for a herniated disc with sciatica, cervical anterior discectomy and fusion (ACDF) for a compressive disc in the neck, and decompressive laminectomy for lumbar stenosis in older patients. I also treat spinal tumours — both those arising from the spinal cord and nerve roots themselves, and metastases from cancers elsewhere — spinal infections, fractures and selected cases of deformity requiring fusion. Most back and neck pain does not need surgery. When it does, the goal is almost always to relieve nerve compression, not to fix pain directly. That distinction matters — and I will always be honest with you about what an operation can and cannot achieve.

Question 17

How much does neurosurgery cost?

Accepted Answer

A neurosurgical operation has several separate costs: the surgeon's fee, the anaesthetist's fee, the hospital account (theatre, ward, ICU if needed), any implants (screws, cages, shunts, plates), radiology and pathology. These are usually invoiced separately. If you are on medical aid, most in-hospital procedures on a hospital plan are covered, but the specifics depend on your scheme and plan. Some plans pay at scheme rates while surgeons and anaesthetists may charge at a different rate — the difference is a co-payment you carry. My rooms will always obtain pre-authorisation from your medical aid before an elective operation and will provide you with a written quote covering my fee. We will also flag any expected co-payment so there are no surprises. Cash patients are welcome. For self-funded procedures we can arrange a package quote with the hospital in advance so the total is known before you commit. If cost is a concern, tell us — there is often more flexibility than patients realise, and delaying necessary surgery for financial reasons usually costs more in the long run.

Question 18

What happens during a neurosurgery consultation?

Accepted Answer

Step one is the history — usually the longest part of the visit. I will ask about your symptoms, their timeline, what makes them better or worse, previous treatments, other medical conditions and medications, family history, and how the problem is affecting your work and home life. Step two is the examination. This is focused on the nervous system relevant to your complaint — cranial nerves and cognition for brain problems, motor and sensory testing for spine problems. I may ask you to walk, do a heel-to-toe test, or check specific reflexes. Step three is the imaging review. We will look at your MRI or CT together on a large screen. I will show you exactly what I am seeing, and how it correlates with your symptoms and examination. Step four is the plan. This might be no further action, a repeat scan in six months, a course of physiotherapy or a nerve root injection, referral to another specialist, or a discussion about surgery. If surgery is on the table, we will talk through risks, benefits, alternatives and expected recovery. You will leave with a written summary and my rooms' contact details. Follow-up questions in the days after are welcome — many patients think of things on the drive home.

Question 19

Do I need surgery for my brain condition?

Accepted Answer

Whether you need surgery depends on three things: the diagnosis, your symptoms, and what happens if we do nothing. All three have to point in the same direction before I will recommend an operation. Some conditions almost always need surgery — a large tumour causing pressure, a ruptured aneurysm, symptomatic hydrocephalus. Others rarely do — small incidental meningiomas, unruptured aneurysms below a certain size, or a disc bulge without nerve compression. Many conditions sit in the middle. Here we watch closely: repeat imaging at set intervals, monitor symptoms, and intervene only if something changes. Watchful waiting is a real treatment decision, not a lack of one. If I recommend surgery, I will explain exactly why the balance tips that way for you. If I recommend against, I will explain what would change my mind and when to come back. You are always entitled to a second opinion. For a decision this important, seek one if it will help you feel confident. I will happily share your notes and imaging with another neurosurgeon.

Question 20

How do I choose the right neurosurgeon?

Accepted Answer

Start with registration. Every neurosurgeon practising in South Africa must be registered with the Health Professions Council of South Africa (HPCSA) as a specialist neurosurgeon. That is a non-negotiable minimum. Then look at experience with your specific problem. A general neurosurgeon handles most conditions well, but for rarer or complex operations — awake craniotomy, complex spinal deformity, skull base tumours — volume in that specific procedure matters. Ask directly how many the surgeon does per year. Consider communication. You will make important decisions with this person. Do they explain things clearly? Do they welcome questions? Do they give you time? If the first consultation feels rushed or dismissive, that is information. Practical factors matter too: which hospital they operate at, whether they take your medical aid, how accessible their rooms are for follow-up. Online reviews are only weakly correlated with surgical outcomes. Word of mouth from a GP you trust, or from a patient who had the same operation, is usually more reliable.

Question 21

What are the most common neurosurgery procedures?

Accepted Answer

On the spinal side, the most common operations are: lumbar microdiscectomy (removing a herniated disc pressing on a nerve), anterior cervical discectomy and fusion (ACDF for a neck disc), and decompressive laminectomy (opening up a narrow spinal canal, usually in older patients with lumbar stenosis). On the cranial side, the most common are: craniotomy for tumour resection, evacuation of a chronic or acute subdural haematoma (often in elderly patients after a fall), insertion of a ventriculo-peritoneal shunt for hydrocephalus, and clipping or coiling of aneurysms in specialised centres. Trauma cases — decompressive craniectomy, spinal fixation after fractures — are less common in elective practice but common in hospital call. Every one of these procedures has its own page on this site with a plain-language explanation of who it is for, how it is done, and what recovery looks like. Start there if a specific operation has been suggested for you.

Question 22

How long is the neurosurgery waiting list?

Accepted Answer

There is no single national waiting list in South African private practice. Timing depends on how urgent your problem is, the hospital and theatre availability, and how quickly your medical aid authorises the procedure. Emergencies — a ruptured aneurysm, an acute subdural, cauda equina syndrome — are operated on the same day. Nothing gets in the way of that. Urgent but not emergent cases — a tumour causing progressive symptoms, a disc with significant weakness — are usually scheduled within one to two weeks. Elective cases — for example, a stable disc with radicular pain that has failed conservative treatment — are typically booked two to four weeks out, mostly to give time for pre-authorisation and pre-operative work-up. If your case is time-sensitive, tell my rooms. We prioritise theatre slots based on clinical urgency, not on the order in which patients booked.

Question 23

Can neurosurgeons treat chronic pain?

Accepted Answer

Neurosurgery treats pain very well when the pain is caused by an identifiable structural problem: a disc pressing on a nerve root, a tumour compressing the spinal cord, trigeminal neuralgia from a blood vessel touching the trigeminal nerve. For these, the operation directly addresses the cause — remove the disc, decompress the nerve, move the vessel off the nerve — and the pain usually improves quickly and dramatically. Neurosurgery is much less useful for generalised chronic pain — widespread back pain without nerve compression, fibromyalgia, or pain that persists years after a previous operation with no new structural cause on imaging. For these, a multidisciplinary pain clinic offers better long-term results than more surgery. A small subset of severe, otherwise untreatable pain can be helped with neuromodulation — spinal cord stimulators or intrathecal pumps. These are specialised procedures done in select centres, and I will refer you if that is the right path. If you are living with chronic pain and are not sure where to start, ask your GP for a referral to either a pain specialist or a neurosurgeon. We will help sort out which category you fall into.

Question 24

What medical records should I bring to my neurosurgeon?

Accepted Answer

Bring your referral letter if you have one — it saves time and gives me your GP's perspective in their own words. Bring all relevant imaging on disc or a memory stick, not just the printed report. I need to see the actual scan images, not just someone else's description of them. Most radiology practices give you a disc at the time of the scan; if not, ring them and ask. Bring recent blood results (usually within three months), particularly if you have diabetes, kidney disease or take blood thinners. Bring any nerve conduction studies, EMGs or bone density scans if you have had them. Bring a written list of every medication, supplement and herbal remedy you take, with doses. Photograph the boxes if that is easier. This matters — several common medications need to be stopped before surgery. If you have had previous spine or brain surgery, bring the operation note and discharge summary. Old records save us from repeating tests and from making avoidable mistakes.

Question 25

Is there a non-surgical alternative to brain surgery?

Accepted Answer

The right treatment for a brain condition is not automatically surgery. For a small meningioma found by chance on a scan, the best treatment is often to watch it with an MRI in a year and see if it grows. For many brain metastases, small aneurysms and certain benign tumours, stereotactic radiosurgery (Gamma Knife, CyberKnife) delivers a highly focused dose of radiation without an incision. It is not a substitute for surgery in every case, but where it applies it is genuinely non-invasive. For most aneurysms, endovascular treatment (coiling or flow diversion, done through a groin catheter) has replaced open surgery as the first-line option. It is done by interventional neuroradiologists working closely with neurosurgeons. Some conditions previously treated surgically — for example many pituitary tumours — are now managed medically with drugs that shrink them. I will always tell you honestly if there is a good non-surgical option for your condition, even if it means referring you elsewhere. Doing the right thing is more important than doing the operation.

Question 26

How do neurosurgeons diagnose brain tumours?

Accepted Answer

The first test in almost every suspected brain tumour is an MRI with contrast. It shows the location, size, shape and vascularity of the lesion, and gives strong clues about what type of tumour it is. Additional imaging is often useful: MR spectroscopy looks at the chemical fingerprint inside the lesion, MR perfusion assesses blood flow, and functional MRI maps important brain areas nearby. In some cases we do a PET scan to look for tumour activity elsewhere. Blood tests, a hearing test (for tumours near the ear), a visual field test (for tumours near the optic pathways) and endocrine bloods (for pituitary tumours) are common add-ons. The definitive answer, however, almost always requires tissue. Either an image-guided needle biopsy or, more commonly, tissue taken at the time of surgical removal is sent to pathology. The final diagnosis — tumour type, grade, and increasingly its molecular signature — drives every treatment decision that follows.

Question 27

What should my family know before my neurosurgery?

Accepted Answer

The person driving you to hospital should know the admission time, the ward, and how long the operation is expected to take. My rooms will call the nominated contact person as soon as surgery is finished. For brain surgery, most patients spend one night in high care or ICU for close monitoring, then move to a normal ward. Visiting hours vary by hospital — check on the day. Warn family that a patient waking up from brain surgery may look worse before they look better: swollen eyelids, tiredness, mild confusion for a day or two. This is expected. It is the neurological function underneath — moving, speaking, understanding — that matters, not the outward appearance. At home, your support person should know what to watch for: worsening headache, new weakness, seizures, high fever, wound drainage, or a marked change in alertness. These warrant an immediate call. Recovery is easier when there is help with cooking, driving, and managing medications for the first week or two. Line this up before admission — it is much harder to organise once you are home and tired.

Question 28

How do I prepare my home for neurosurgery recovery?

Accepted Answer

Sleep somewhere that avoids stairs for the first week if possible. A recliner or well-supported bed helps after a craniotomy or ACDF, when lying flat can feel uncomfortable. Remove obvious trip hazards: loose rugs, cables across walkways, cluttered floors. After brain or spinal surgery, balance can be temporarily off and a fall can undo weeks of recovery. Prepare easy meals in advance — freezer meals, easy-to-open snacks, plenty of fluids within reach. Cooking is often the first activity that feels overwhelming. Sort out medications before you leave hospital. Get scripts filled, set up a weekly pill organiser, and know exactly when to stop things like anti-seizure medication or pain relief. Arrange transport for follow-up appointments, since driving is restricted after most neurosurgical operations. And do not underestimate how much rest you will need in week one — clear the diary, decline visitors, and let recovery be your only job.

Question 29

Can neurosurgeons treat aneurysms?

Accepted Answer

A brain aneurysm is a weak spot on the wall of an artery in the brain, which can balloon out and — rarely — rupture. Not every aneurysm needs treatment; many small, stable ones are simply monitored. When treatment is needed, there are two options. Endovascular coiling (or newer techniques like flow diversion) is performed by an interventional neuroradiologist through a small catheter in the groin. No incision on the head is made. This is now the first-line treatment for most aneurysms. Surgical clipping remains the right choice for certain aneurysms — particularly larger, wider-necked ones and those in specific locations. It involves a craniotomy and placing a tiny titanium clip across the neck of the aneurysm. Which one is right depends on the aneurysm's size, location, shape and your overall health. This is always a joint decision between the neurosurgeon and the interventional neuroradiologist. If you are diagnosed with an aneurysm, I will make sure both options are considered. A ruptured aneurysm is a neurosurgical emergency. Anyone with a sudden, severe "thunderclap" headache — the worst of their life — must go straight to a hospital with neurosurgical services.

Question 30

What is minimally invasive neurosurgery?

Accepted Answer

Minimally invasive neurosurgery covers techniques that achieve the same surgical goal through a smaller opening, with less disruption to healthy tissue. On the spine, this includes tubular microdiscectomy, minimally invasive lumbar decompression, and percutaneous pedicle screw fixation. Recovery is usually faster, blood loss is lower, and post-operative pain is less. On the cranial side, endoscopic transnasal surgery for pituitary tumours goes through the nose without any external incision. Endoscopic third ventriculostomy treats hydrocephalus without inserting a shunt. Keyhole craniotomies use small openings for selected tumours. The important honest caveat: minimally invasive is a tool, not a virtue. If a problem is best solved with a traditional open approach, doing it through a smaller hole for the sake of it makes surgery harder and outcomes worse. I will always recommend the approach that gives the best result for your specific case.

Question 31

How much recovery time should I plan for neurosurgery?

Accepted Answer

For a lumbar microdiscectomy: expect one to two weeks off desk work, four to six weeks off physical work, and no gym or contact sport for six weeks. For an ACDF or cervical disc surgery: two to three weeks off desk work, six to eight weeks off physical work, driving after two to three weeks provided you can turn your head comfortably. For a craniotomy: two to six weeks off work depending on the operation and your job. Driving is legally restricted after a craniotomy — typically for at least four weeks and longer if there were seizures. Air travel is usually fine after two to four weeks. For a lumbar fusion: office work at four to six weeks, physical work at three months, and full return to sport at six months once the bone has fused. These are averages. Your recovery might be faster or slower, and I will personalise it at your follow-up visit. Return to work is not just about the incision — it is about concentration, tiredness and safety on the job.

Question 32

What medications should I stop before neurosurgery?

Accepted Answer

Blood thinners are the most important category. Aspirin, clopidogrel (Plavix), warfarin and the newer oral anticoagulants (rivaroxaban, apixaban, dabigatran) all need to be stopped or bridged in a specific way, usually five to seven days before surgery. Do not stop them on your own — some carry their own risk when discontinued. Non-steroidal anti-inflammatories (ibuprofen, diclofenac, naproxen) increase bleeding risk and are usually stopped one week before surgery. Paracetamol is safe. Several supplements act as mild blood thinners and should be stopped: fish oil, vitamin E, garlic tablets, ginkgo, ginseng and turmeric supplements. Stop these one week before. Diabetes medications are adjusted, not always stopped. Metformin is often held on the day of surgery. Insulin doses are usually reduced during the fasting period. Newer diabetes drugs (GLP-1 agonists, SGLT-2 inhibitors) have specific fasting rules — tell us if you take these. You will receive a written medication plan with your surgery date. If anything is unclear, phone the rooms rather than guess. Never stop or change a medication without checking.

Question 33

Do all brain tumours require surgery?

Accepted Answer

The word "tumour" is frightening, but many brain tumours are benign, slow-growing, and can be safely watched. A small meningioma found on a scan done for another reason may be observed for years without any intervention. Small pituitary tumours are often managed with medication that shrinks them, without any operation. Metastases from cancer elsewhere are often treated with stereotactic radiosurgery rather than open surgery, particularly if there are multiple lesions or the patient is not fit for a craniotomy. Surgery is definitely required when a tumour is causing pressure symptoms, when it is growing on serial scans, when a definitive tissue diagnosis is needed to guide treatment, or when the type and location make surgery the clear best option. If you have been told you have a brain tumour, the next step is not automatically an operation. It is a careful conversation about type, size, location, symptoms and options — and often a multidisciplinary discussion before any decision is finalised.

Question 34

How do neurosurgeons access brain tumours during surgery?

Accepted Answer

Every craniotomy starts with a plan built on the MRI: the shortest safe corridor from the surface of the brain to the tumour, avoiding critical structures like the speech area, motor pathways and major blood vessels. Neuronavigation — think GPS for the brain — is loaded with the pre-operative MRI and tracks the position of the instruments in real time. It tells us exactly where we are inside the head. The scalp is opened, a section of bone is temporarily removed, and the dura (the tough covering of the brain) is opened. Under the operating microscope, we then work through natural spaces between brain structures wherever possible, following the planned corridor. For tumours near the speech or motor areas, we may wake the patient up during the operation to test speech and movement in real time. Awake craniotomy sounds dramatic but is safe and lets us remove more tumour without causing a deficit. At the end, the dura is closed, the bone is replaced with tiny plates and screws, and the scalp is closed in layers. Most patients are moving all four limbs and talking normally within hours of coming out of theatre.

Question 35

What are the success rates for brain tumour surgery?

Accepted Answer

There is no single "success rate" for brain tumour surgery, because the numbers depend entirely on what kind of tumour it is. Removing a small benign meningioma has very different odds to removing a deep glioblastoma. For benign tumours in surgically accessible locations — most meningiomas, schwannomas, colloid cysts, many pituitary tumours — complete removal is often possible with very low risk of new neurological problems, and long-term outcomes are excellent. For malignant primary brain tumours — high-grade gliomas — surgery is only one part of the treatment. The goal is maximal safe removal, followed by radiation and chemotherapy. Survival has improved significantly in the last decade but remains a serious diagnosis. For metastatic tumours (spread from cancer elsewhere), surgery is often combined with radiation. Outcomes depend heavily on the primary cancer and how it is responding to systemic treatment. The most useful number is not a general statistic but the one specific to your tumour, in your location, at your age and health. I will give you those numbers honestly before you consent, so your decision is based on your reality, not a headline figure.

Question 36

Can neurosurgeons treat epilepsy?

Accepted Answer

Epilepsy is primarily managed by neurologists with anti-seizure medication. Most patients gain excellent control with the right combination of drugs. About a third of patients continue to have seizures despite adequate medical treatment. For these patients — particularly if seizures come from a single identifiable area of the brain — surgery may be an option. The most common epilepsy operation is temporal lobectomy for mesial temporal sclerosis, which has very high rates of seizure freedom. Other options include lesionectomy (removing a specific lesion causing seizures), disconnection procedures, and neuromodulation devices such as vagus nerve stimulators. Deciding on epilepsy surgery is a big undertaking. It requires detailed investigation — long-term video EEG monitoring, high-resolution MRI, neuropsychological testing, and often invasive electrode recordings — usually in a dedicated epilepsy surgery centre. If your seizures are not controlled despite trying two or more medications properly, ask your neurologist about a referral to an epilepsy surgery programme. Surgical options are considered too late in many patients.

Question 37

How do I find a neurosurgeon near me?

Accepted Answer

The best route is a GP or specialist referral. Your GP knows which neurosurgeons in your area handle which types of cases and will send you to someone appropriate to your specific problem. Every practising neurosurgeon in South Africa is listed on the HPCSA register (hpcsa.co.za). You can verify anyone's registration and qualifications online for free. Check which hospitals a surgeon operates at and whether those hospitals are on your medical aid's network. This affects both cost and convenience. For patients in Johannesburg's West Rand, my practice is based at Life Wilgeheuwel Hospital in Roodepoort. I see patients from across Gauteng and further afield. My rooms can be reached via the Contact page on this site. For urgent or complex cases outside my area, I am happy to point you to a colleague who is a better fit. Getting to the right surgeon is more important than getting to the closest one.

Question 38

What does a neurosurgeon do during a consultation?

Accepted Answer

A neurosurgery consultation is not a scan review. It is a structured medical assessment that happens to include your imaging. I listen first. Your history is the single most important piece of information — more than any scan. Where the pain is, what makes it worse, when it started, what has been tried, what you can and cannot do because of it. I examine next. A focused neurological examination often takes only five minutes but frequently changes the diagnosis compared to what the scan alone would suggest. Only then do I look at your imaging with you, and correlate the findings to your history and examination. A disc bulge on MRI is only surgically relevant if it matches your symptoms and examination — otherwise it is just a picture. Finally, I explain my thinking, present the options, and we make a plan together. You should leave understanding not just what I recommend but why.

Question 39

How do I know if my neurosurgeon is qualified?

Accepted Answer

In South Africa, a qualified neurosurgeon holds specialist registration with the HPCSA in the category "Neurosurgery". You can verify this at hpcsa.co.za by searching the practitioner's name. If they are not on that register, they are not a neurosurgeon. Specialist qualification requires an MBChB (medical degree), followed by internship, community service, and then six years of neurosurgical training culminating in the FC Neurosurg (SA) or MMed exam. Additional fellowships in sub-specialties — vascular, skull base, spine, paediatric — are done after specialist qualification, either locally or abroad, and are a useful marker of extra depth in that area. Membership of professional societies such as the Society of Neurosurgeons of South Africa (SNSA) or the World Federation of Neurosurgical Societies (WFNS) indicates ongoing engagement with the profession. Hospital appointments matter too — operating in an accredited private hospital means the surgeon has been credentialed by that hospital's medical advisory committee. Do not hesitate to ask about any of this. A good surgeon will be pleased that you did.

Question 40

What imaging tests do neurosurgeons use?

Accepted Answer

MRI (magnetic resonance imaging) is the workhorse of neurosurgical imaging. It shows soft tissue — brain, spinal cord, discs, nerves — in exquisite detail. Most elective neurosurgical decisions rest on an MRI. CT (computed tomography) uses X-rays and is faster, cheaper and better for looking at bone and acute bleeding. CT is the first scan in trauma and stroke because it is available immediately. CT and MR angiography visualise the blood vessels of the brain and neck, used to diagnose aneurysms, vascular malformations and vessel narrowing. Digital subtraction angiography (DSA) — the gold standard — involves a catheter through the groin and is done in specialised centres. Functional MRI maps active brain areas — speech, movement, vision — before surgery near critical regions. Diffusion tensor imaging maps white matter pathways for the same purpose. PET scans are used mainly to distinguish active tumour from post-treatment scarring, and to look for metastatic disease elsewhere. Nerve conduction studies and EMG assess how well individual nerves and muscles are working — essential for many peripheral nerve and spine cases.

Question 41

Can neurosurgery cure my brain condition?

Accepted Answer

Some neurosurgical conditions are genuinely cured by an operation. A complete removal of a benign meningioma, a successful clipping of an unruptured aneurysm, a microdiscectomy that resolves sciatica — these end the problem. Others are controlled but not cured. A shunt for hydrocephalus manages the pressure indefinitely but the underlying condition remains. A lumbar decompression relieves the leg pain but the aging spine still ages. For malignant tumours, surgery is one part of a longer treatment plan. Even a complete-looking removal often needs radiation and chemotherapy afterwards. The word "cure" applies to some and not to others, depending on tumour type and biology. I will tell you plainly which category your condition falls into before you consent. Setting the right expectation is one of the most important things I do — because a successful operation that did not deliver what you were hoping for feels like a failure, and it should not.

Question 42

What should I eat before and after neurosurgery?

Accepted Answer

In the weeks before surgery, eat normally and well. Focus on adequate protein (fish, chicken, eggs, beans, dairy), plenty of vegetables and fruit, and enough calories to maintain your weight. This is not the time to start a restrictive diet. If you are underweight or have been eating poorly, we may add a nutritional supplement drink for a few weeks pre-operatively. If you are significantly overweight, modest weight loss over months helps outcomes — but crash dieting immediately before surgery does not. On the day of surgery, follow the fasting instructions exactly: usually no solid food from midnight and clear fluids allowed up to two hours before anaesthesia. Modern anaesthesia is safer with a shorter clear-fluid fast. After surgery, start with what you feel like eating — often that is plain toast or fruit initially. Move to a normal balanced diet as your appetite returns. Aim for protein at every meal to support wound healing. Stay well hydrated, aim for regular gentle activity, and prioritise sleep. These do more for recovery than any specific superfood or supplement.

Question 43

How do neurosurgeons prevent infection after brain surgery?

Accepted Answer

Preventing infection starts before the incision. A single dose of intravenous antibiotics is given within an hour of the skin cut. The hair is either not shaved or clipped just before surgery, not the night before. The skin is prepared with a strong antiseptic. In theatre, everything that touches the surgical field is sterile — instruments, drapes, gloves, gowns. Air flow in the operating room is carefully controlled. The wound is irrigated during closure. The scalp is closed in layers so that no cerebrospinal fluid can leak through, and a light dressing is applied. Most craniotomy wounds are essentially dry within 24 hours. At home, keep the wound clean and dry. You can shower gently after 48 hours in most cases; avoid baths, swimming and shampoos with strong fragrances until sutures or staples are removed at about ten days. Warning signs to call about: increasing redness or swelling, wound drainage, fever above 38°C, or worsening headache. These are uncommon but need prompt attention.

Question 44

What is the cost of brain tumour surgery?

Accepted Answer

A brain tumour operation is billed by several parties: the surgeon, the anaesthetist, the assistant, the hospital, radiology (intra-operative navigation, post-op imaging) and pathology. For patients on medical aid, most tumour surgery is covered as a Prescribed Minimum Benefit under South African law, meaning the medical aid must pay for it at the appropriate level. What you may be liable for is a co-payment where surgeon or anaesthetist fees exceed scheme rates. My rooms will always obtain pre-authorisation from your medical aid before an elective operation. You will be given a written quote for my fee, and can request quotes from the hospital and anaesthetist too. This means you know the maximum you may pay out of pocket before you commit. For cash-paying patients, a bundled quote from the hospital covering theatre, ICU (usually one night), ward stay and standard imaging can be arranged. My fee and the anaesthetist's fee are separate. Never let cost concerns delay a genuinely urgent tumour operation without discussing it with us — there is often more flexibility than you would expect, and delayed treatment usually costs more in every sense.

Question 45

How long will I be in hospital after neurosurgery?

Accepted Answer

For lumbar microdiscectomy: usually one night, sometimes discharged the same day if surgery is early and recovery is smooth. For anterior cervical discectomy and fusion (ACDF): one night in hospital, sometimes two. For a straightforward craniotomy — small tumour, no complications: one night in high care or ICU, then two to three days on the ward. Total stay three to four nights. For a lumbar decompression or fusion: two to five nights depending on how many levels are operated on and how mobile you are after surgery. For complex tumour surgery or surgery in older patients with other medical problems: expect longer, and expect that the plan may change based on how you recover. We will give you a realistic estimate at the pre-operative visit and update it daily in hospital.

Question 46

Can I drive after neurosurgery?

Accepted Answer

After a lumbar microdiscectomy, most patients can drive short distances within a week, once they are off strong pain medication and can sit comfortably. After an ACDF or other cervical spine surgery, driving usually resumes at two to three weeks — the limit is your ability to turn your head to check blind spots and to react quickly. After a craniotomy, driving is restricted for a minimum of four weeks. If there have been any seizures — before or after surgery — the restriction is longer and driving cannot resume until you have been seizure-free for a defined period (usually at least six months for private driving). For commercial drivers (heavy vehicles, professional drivers), the rules are stricter and I will discuss them with you individually. The legal and insurance responsibility for driving lies with you. If in doubt, do not drive — a moment of inattention or a first seizure at the wheel can cause serious harm to yourself and others.

Your neurosurgery questions, answered.

The practical essentials

40 doctor-written answers

Your neurosurgery questions, answered.

The practical essentials

How do I book a consultation with Dr Human?

Do I need a referral from my GP?

What should I bring to the first appointment?

Do you accept medical aid?

How long is the first consultation?

Where are your rooms?

40 doctor-written answers

Before your appointmentWhat should I expect at my first neurosurgeon appointment?

Preparing for surgeryHow do I prepare for brain surgery?

Conditions & proceduresDo neurosurgeons remove brain tumours?

Conditions & proceduresWhat conditions do neurosurgeons treat?

RecoveryHow long does neurosurgery recovery take?

Surgery decisionsIs brain surgery safe? What are the risks?

Before your appointmentWhat questions should I ask my neurosurgeon?

When to see a neurosurgeonHow do I know if I need a neurosurgeon?

When to see a neurosurgeonWhat's the difference between a neurologist and a neurosurgeon?

Conditions & proceduresCan neurosurgeons treat spine problems?

Cost, access & familyHow much does neurosurgery cost?

Before your appointmentWhat happens during a neurosurgery consultation?

Surgery decisionsDo I need surgery for my brain condition?

Before your appointmentHow do I choose the right neurosurgeon?

Conditions & proceduresWhat are the most common neurosurgery procedures?

Cost, access & familyHow long is the neurosurgery waiting list?

Conditions & proceduresCan neurosurgeons treat chronic pain?

Before your appointmentWhat medical records should I bring to my neurosurgeon?

Surgery decisionsIs there a non-surgical alternative to brain surgery?

Conditions & proceduresHow do neurosurgeons diagnose brain tumours?

Cost, access & familyWhat should my family know before my neurosurgery?

RecoveryHow do I prepare my home for neurosurgery recovery?

Conditions & proceduresCan neurosurgeons treat aneurysms?

Conditions & proceduresWhat is minimally invasive neurosurgery?

RecoveryHow much recovery time should I plan for neurosurgery?

Preparing for surgeryWhat medications should I stop before neurosurgery?

Surgery decisionsDo all brain tumours require surgery?

Conditions & proceduresHow do neurosurgeons access brain tumours during surgery?

Surgery decisionsWhat are the success rates for brain tumour surgery?

Conditions & proceduresCan neurosurgeons treat epilepsy?

When to see a neurosurgeonHow do I find a neurosurgeon near me?

Before your appointmentWhat does a neurosurgeon do during a consultation?

Before your appointmentHow do I know if my neurosurgeon is qualified?

Conditions & proceduresWhat imaging tests do neurosurgeons use?

Surgery decisionsCan neurosurgery cure my brain condition?

Preparing for surgeryWhat should I eat before and after neurosurgery?

RecoveryHow do neurosurgeons prevent infection after brain surgery?

Cost, access & familyWhat is the cost of brain tumour surgery?

RecoveryHow long will I be in hospital after neurosurgery?

RecoveryCan I drive after neurosurgery?