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Exciting times ahead

New Zealand's first Professor in Neurosurgery, Dirk De Ridder, is well underway with plans to make the University of Otago a world-leading academic neurosurgery unit.

For leading Belgian neurosurgeon and brain researcher Dirk De Ridder, the road to medicine was fairly straightforward. Unlike his four-year-old peers who were investigating careers as super heroes and racing-car drivers, a young Dirk announced to his parents that he would be a doctor like his father. And he never looked back.

“I always wanted to do medicine so, after primary and secondary school and a year in the US as an exchange student, I came back and started studying medicine,” says De Ridder.

“Neurosurgery was by far the area that attracted me the most – because I wanted to do something incredibly challenging that would make a real difference.”

De Ridder, who began his five-year tenure as Otago's inaugural Neurological Foundation Professor of Neurosurgery in January, says he was “lucky” to be chosen in his year group to study neurosurgery.

“At that time you could still put your training programme together yourself essentially and, for me, this was ideal. In this way, I was able to look at different neurosurgical centres and put together a programme that permitted me to get a very intense, but wonderfully exciting, training.”

Interested in skull-based surgery and trauma, an eager De Ridder took up several stints in hospitals in Belgium and South Africa while a resident neurosurgeon, after gaining his medical qualifications from the University of Ghent in Belgium in 1992. While he believes there was probably a “genetic pathology” (both his father and mother are professors) that would have inevitably led him into academic research, it was the months spent in South Africa where his interest in science began.

“In South Africa, theoretical knowledge was a lot higher than in Belgium, where surgical technique is key. I remember being on a ward round with a huge group, the professor kept calling me up to ask me questions about each patient. By the end of it, I realised I needed to do a whole lot more study.”

De Ridder says he returned from South Africa a “stranger” – passionate about “reading and writing” and finding out the knowledge behind the conditions he was treating. From there, after a short time in private practice, he got a place at one of Belgium's leading hospitals in 2000, Antwerp University Hospital. He gained his PhD in 2005 and became a Professor of Neuromodulation and Neurosurgery, founder and director of a brain research centre and a tinnitus research initiative in Antwerp.

The lure of Otago – where he heads the country's first academic neurosurgery unit, spending half his time on research and teaching at the University, and half as a neurosurgeon at Dunedin Hospital – was two-fold.

“I love it here. Because there are so many people of really high quality in the basic neuroscience unit, it's very interesting. This afternoon I will talk to [Associate Professor] John Reynolds about how the brain tells you it's getting a reward, because how I look at it is different to how the scientists look at it. Next week I will meet with [Professor] Cliff Abraham [Director of Otago's Brain Health Research Centre] about how we can use what I have been doing to help people with early-stage Alzheimer's.

“That is what is unique about this location – because you're somewhat isolated here, it actually forces you to collaborate. There has been a recent paper that shows that the amount of real collaboration is directly related to the physical distance between the collaborators. I'm just across the road from people I want to collaborate with. It's incredibly unique.”

Since arriving in Dunedin in January, De Ridder has also enjoyed a renewed quality of life – another aspect that attracted him to the job. De Ridder and his wife Karin Ongena (a general surgeon specialising in breast surgery) travelled around New Zealand in 1998 and they both liked the country. His brother, Koen, a paediatric orthopaedic surgeon, now lives in Wellington, so when the opportunity came up, the family didn't have to think about it. De Ridder says he has already enjoyed more time with sons Maarten (11) and Stijn (13) without the long commutes in Belgium.

“We even went surfing and mountain biking together – that's something we've never done before.”

De Ridder is conscious of, but not concerned by, the fact that his position was created and funded by the public – the Neurological Foundation, together with the University and Southern DHB, raised an impressive $3 million through public support to fund the position in perpetuity. He is eager to perform and has big plans for the role in both the clinic and the lab. He is looking to extend the offering of elective neurosurgeries, with fellow neurosurgeons senior lecturer Reuben Johnson and Ahmad Taha, as well as new research collaborations with colleagues at Otago's Brain Health Research Centre, while continuing and extending his international collaborations.

De Ridder is a world expert in the area of brain modulation (simply put, the different ways – invasive or non-invasive – you can change brain function). This involves electrically stimulating parts of the brain to dampen down hyperactive neurons. Neuromodulation has been used to treat a range of disorders including Parkinson's disease, Tourette syndrome, pain, depression and stroke rehabilitation. De Ridder has used it as a treatment for tinnitus (ringing in the ears), pain, depression and addiction.

“My interests in research are very different from my surgical interests. The reason is very simple – my research requires you to understand how the brain works. It's a fundamental curiosity that drives my interest – trying to understand how the brain works and how we can then translate that to the clinic by doing invasive or non-invasive stimulation, or EEG feedback where you basically train brain activity by reconditioning it.

“If these work, how do we then turn it into a neurosurgical procedure, which would basically be an implant of an electrode? This is intellectually extremely interesting – because it really allows you to try to understand the brain in a fundamental way – but it's surgically extremely boring, because it's just putting in an electrode.

“My surgical interests are skull-based surgery. So I try to combine those by having a surgical expertise that has nothing to do with my research interests.”

While to date there hasn't been much teaching in the new role, De Ridder would like to offer introductory papers in neurosurgery at undergraduate level in order to “demystify” the role. This would serve to educate future GPs about what neurosurgeons can offer their patients and, he hopes, attract more students into the field to address the “scary” figure of just several Kiwi neurosurgeons currently in practice. De Ridder is also keen to offer an introductory course on neuromodulation as an add-on to what students get taught in neuroscience and neurology.

“Using electricity to treat conditions is very old – the Egyptians used electrical fish to treat gout and pain and, depending on how much current they wanted to use to suppress the pain, they used a bigger or smaller fish. It was trial and error, but what's new is that now you can use knowledge to go and target the disease – and the knowledge has only become available because of the new technology; primarily, functional brain imaging.”

Newer still are De Ridder's international collaborations using “burst stimulation”. Rather than “blocking” neuron activity and hoping good will come of it, his latest projects involve simultaneously stimulating brain activity in two areas in order to “drive” brain function, specifically, to treat tinnitus.

Aside from his research, De Ridder is also keen to collaborate more in the clinic with fellow neurosurgeons based in Christchurch and Wellington in order to introduce regional sub-specialisation – something necessary to keep New Zealand competing on a world stage, with an extra benefit of attracting more postgraduate students.

“I think that's critically important if we want to stay at the same level of expertise as the rest of the world. The time of the general neurosurgeon is over, not that you don't have to be able to do everything. The first stage is for us all to meet and voice our main interests and draw up a map to see how it can be practically organised.

“I come from a unit where trauma was less than 10 per cent of what we did. We were doing mostly elective surgeries.

“Currently in Dunedin, the major work is still too much based on emergencies. I hope to change this in the future to a more elective pathology, but you can only do that if there are enough neurosurgeons and if people know what we can offer as treatments.

“That's why I propose to hold clinics, not just in Invercargill, but also Dunstan and Oamaru and Timaru, and, when we go, we do a teaching session about neurosurgeons and the pathology we cover. With the new unit, we have a real opportunity to make a difference. It's an exciting time ahead.”


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