Brain surgery is mostly done for tumours, trauma, bleeding from vascular anomalies, hydrocephalus or pain. Dr Biggs training and overseas fellowships make him an expert in surgery for brain tumours, and cranial nerve compression syndromes (trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia). Dr Biggs trained with Prof Peter Janetta who popularized the operation of microvascular decompression for trigeminal neuralgia.
Microvascular decompression (MVD) is a surgical procedure for the treatment of cranial nerve compression syndromes. The commonest of these syndromes is Trigeminal Neuralgia (severe pain affecting one side of the face). Other syndromes include Hemifacial Spasm (severe involuntary twitching of one side of the face), and Glossopharyngeal Neuralgia (severe pain in one side of the throat associated with swallowing).
The surgery involves making a hole in the skull behind the ear, opening the lining of the brain (dura) and inspecting the origin of the affected cranial nerve using the microscope for magnification and illumination.
In most cases a blood vessel, usually an artery, sometimes a vein, is found to be compressing the origin of the nerve. The vessel is carefully moved away from the nerve. It is held away with one or more small pieces of woven fabric (Teflon), which remains in place and cushions the nerve from the vessel.
The surgery is successful in more than 85% of cases and allows the patient with severe Trigeminal Neuralgia to wean off the anticonvulsant medication which has been the mainstay of their medical treatment.
Base of Skull Surgery
Tumours and vascular abnormalities such as aneurysms frequently occur at the base or floor of the skull. These abnormalities provide a significant surgical challenge in view of the fact that most of the major blood vessels to and from the brain, as well as most of the cranial nerves traverse this space.
In recent times neurosurgeons have developed specific skills and equipment to allow surgery to be done safely in this domain which was previously thought to be inoperable. Advances in magnification and illumination with state of the art operating microscopes, computer generated neuronavigation equipment, laser technology, flexible and rigid endoscopes allowing minimally invasive keyhole surgery, rigid fixation retractor systems and intraoperative stimulation and monitoring machines, have all made this type of surgery more feasible.
Combined approaches with Ear, Nose and Throat Surgeons and Head and Neck Surgeons have allowed Dr Biggs to remove difficult tumours at the Base of Skull via trans-nasal and cranio-facial approaches. Advances in endoscopes and specific drills allow this delicate surgery of the brain to be done through the nose.
Brain Tumour Excision
Dr Biggs has widespread experience in surgery for brain tumours including gliomas, glioblastoma, meningioma, metastases, ependymoma, acoustic neuroma (vestibular schwannoma), epidermoids and other rarer tumours.
In 1999 he co-founded Sydney Neuro-Oncology Group, a charitable organization aimed at providing education, patient and family support, and research into brain cancer (www.snog.org.au). SNOG collects data on brain and spinal tumour patients and enters this into a comprehensive database linked to the Australasian Brain tumour bank, which it established 15 years ago.
SNOG fund a laboratory in the Kolling Institute, part of the University of Sydney, and are involved in supervision of PhD students doing research into causation and treatment of brain tumours. The group provide a multidisciplinary approach to brain tumour management incorporating surgical management, radiotherapy and chemotherapy management.
Using the latest equipment (pre-operative imaging, stereotactic navigation, ultrasonic aspiration, and Zeiss/Leica microscopes) allows Dr Biggs to deal with complex brain tumours in a much safer way than has been the case historically.