Christos Tolias1, Jin Ye Yeo2
1Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK; 2ASJ Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. ASJ Editorial Office, AME Publishing Company. Email: asj@amegroups.com
This interview can be cited as: Tolias C, Yeo JY. Meeting the Editorial Board Member of ASJ: Dr. Christos Tolias. AME Surg J. 2025. Available from: https://asj.amegroups.org/post/view/meeting-the-editorial-board-member-of-asj-dr-christos-tolias.
Expert introduction
Dr. Christos Tolias (Figure 1) has been a Consultant Neurosurgeon at King’s College Hospital since 2005. He has a PhD in Biological Sciences from the University of Warwick, and extensive research experience in traumatic brain injury and the mechanisms of brain cell death. He undertook specialist training in Neurosurgery in Liverpool and Birmingham followed by a Clinical Fellowship in Richmond, Virginia, USA. He is the Lead Neurovascular Surgeon at King’s College Hospital, Clinical Lead in Neurosurgery, and Chair of the British Neurovascular Group (BNVG).
He was the first surgeon in the UK to perform the non-occlusive cerebral vascular bypass technique. In addition to his expertise in degenerative spine disease, which includes the management of back and neck pain, arm pain, and sciatica, he has specialist expertise in the management of neurovascular conditions (cerebral aneurysms, AVMs, cavernomas, AV fistulas), the surgical treatment of stroke (decompressive craniectomy and revascularization for Moyamoya disease, sickle cell anemia) and trauma. His expertise extends to the use of radiosurgery (CyberKnife and GammaKnife) for treating these conditions.
Figure 1 Dr. Christos Tolias
Interview
ASJ: What inspired you to pursue a career in neurosurgery, and how did you develop a particular focus on neurovascular conditions?
Dr. Tolias: Throughout my medical school years, I was fascinated by the brain and the intricacies of the nervous system. It was clearly a challenge to learn and an amazing privilege to be able to treat conditions affecting those structures. While progressing in my postgraduate training, I was fortunate to come across neurosurgeons who introduced me to the specialty and encouraged me to follow this singularly demanding career. I have always been a strong believer in the success and effectiveness of a focused approach to any problem. I often tell my younger colleagues and medical students that, should they decide to follow such a path in their careers, they should be prepared to face the challenges head-on and not sigh away from the inevitable difficulties. If you like and enjoy what you do, inevitably, it will lead to success and the attainment of goals. Moreover, being aware of opportunities that may arise at any moment in achieving this goal. For me, this type of opportunity came at a meeting completely out of the blue when I approached one of the premier neurosurgeons of the previous generation, Dr Ross Bullock, who invited me to join his research team. I was able to do that and also developed an understanding of neurovascular conditions. This way, I was able to join a very busy unit in London, UK, Kings College Hospital, one of the biggest neurosurgical units in London and nationally. I was, therefore, exposed to an opportunity at the time of changes in the subspecialty. The ISAT trial had caused significant upheaval, to put it mildly, in the neurosurgical circles as it appeared that a major part of the neurosurgical specialty would be completely changed and possibly even become obsolete. Again, for me, it was a challenge not completely planned but also a significant opportunity. I was and remain a strong believer in the need to develop and maintain surgical expertise for these challenging pathologies and also to maintain ownership of the subspecialty, which is in danger of losing its neurosurgical leadership. For those reasons, I focused all my energy on developing the neurovascular department at King’s, which evolved to have three full-time neurovascular surgeons, five interventional neuroradiologists, neurologists, and specialist nurses who treat not only adults but also pediatric cases. We also have established the first Royal College of Surgeons Certified Fellowship in Neurovascular Surgery in the UK, and we are proud that the majority of Neurovascular Surgeons in the UK currently (and a number abroad) have at some point been our fellows.
ASJ: As the Lead Neurovascular Surgeon and Clinical Lead in Neurosurgery at King’s College Hospital, what are the biggest challenges you face in these leadership roles?
Dr. Tolias: Kings College Hospital in London UK is one of the largest neurosurgical units in London and nationally. Our department has grown significantly since I started back in 2005. We are now a unit of 20 consultants with all the neurosurgical and spinal subspecialties. We cover a population of more than 4 million, and we perform an excess of 5000 operations a year. As a result, managing a unit of that size requires patience and good interpersonal relationships. The biggest challenges that we face have to do with the need to balance the ever-expanding needs of our patients with the limited resources available. The modern neurosurgical unit for change in techniques and equipment is much faster than other specialties. We are treating much more complex conditions, as well as older and aging populations. At King’s, we pride ourselves on having a very coherent and close-knit unit, which helps us navigate these challenging times
ASJ: You are also the Chair of the British Neurovascular Group (BNVG). How has this role allowed you to shape neurovascular care and research in the UK?
Dr. Tolias: I was honored to be elected as President of the British Neurovascular Group (BNVG) a year ago. This group brings together all the neurovascular consultants and trainees, as well as associated specialists around the UK. It is a family of similar-minded individuals who practice an increasingly challenging and specialized craft that has changed enormously over the last few decades. The endovascular management of cerebral aneurysms has revolutionized the management of these complex pathologies. This powerful tool has brought significant benefits to patients but also has created challenges in the subspecialty. The rapid expansion of the use of these techniques has led to the real risk of neurosurgery losing its leading role in the management of this complex pathology. This is particularly more critical in countries like the UK, where dual endovascular and neurosurgical training is not currently available. The development of robust neurovascular multi-disciplinary teams (MDTs) has allowed appropriate support and development of both arms of the subspecialty. However, the rapid expansion of thrombectomy for stroke and the need for 24/7 coverage has changed the equilibrium. My main aim in the 2 years as Chair has been to promote and foster discussion and development of more joint approaches to neurovascular pathology as well as assist the development of potential for known radiologists in endovascular techniques, i.e. dual-trained neurosurgeons. I am also very keen to continue supporting and expanding proper surgical neurovascular fellowships, which will continue to train future neurosurgeons in the surgical techniques of neurovascular surgery.
ASJ: Radiosurgery techniques like CyberKnife and GammaKnife have transformed neurovascular treatment. In which cases do you find these methods most effective compared to traditional surgical interventions?
Dr. Tolias: CyberKnife and GammaKnife have had a significant impact in the management of a large number of neurosurgical conditions. I would not, however, agree that they have transformed neurovascular treatment. In my view, they are extremely effective techniques that, when used appropriately, can assist in the management of complex neurovascular conditions. However, their application has sometimes been over-promoted with little support from the existing literature and evidence. There is no question that they offer extremely valuable treatment options, which, of course, are non-invasive. However, their use and application have to be controlled through robust neurovascular MDTs in order to provide a rationale that is evidence-based and appropriate to the individual patient’s needs.
ASJ: How have your findings on brain cell death influenced your approach to neurosurgical interventions, particularly in trauma cases?
Dr. Tolias: As part of my training in neurosurgery, I studied at the University of Warwick for a PhD through an Action Research Fellowship. I explored mechanisms of neuronal cell death, particularly in relationship with free radical and nitric oxide production. Involvement in lab research helped me understand the difficulties we face in interpreting the pathophysiological mechanisms underlying brain cell death and, of course, brain trauma. It became clear that the translation of basic science findings to human trials and effective treatments has been less than successful. This has been painfully obvious over the years with the failure of the number of pharmacological trials in the management of brain injury. However, engagement in research in the proper academic/lab environment remains, in my view, a fundamental aspect of neurosurgical training, as it provides understanding and hones skills that are unavailable otherwise to future surgeons.
ASJ: With the rapid evolution of neurosurgical technology, how do you see the shift toward less invasive or even robotic-assisted neurovascular surgery in the future?
Dr. Tolias: New technologies are rapidly changing the landscape of medicine. Artificial intelligence (AI) is revolutionizing pharmacological research and diagnostics. In neurosurgery, minimally invasive access is developing, particularly through endovascular techniques. Also, GammaKnife and CyberKnife have significant impacts on the management of complex pathologies, particularly skull-base conditions. The advent of robotics is impacting surgical specialties like Urology but has had limited inroads into neurosurgery to date. However, there are significant developments in the field that could potentially expand its use in complex procedures. Brain surgery is, of course, already benefiting from image guidance that allows targeted and less destructive approaches and difficult-to-get areas of the brain. Combining these technologies with robotics has already allowed specialized treatments for difficult-to-get lesions (Visualase). Robotic arms may soon have a role in long and delicate intracranial procedures as well. We should also not forget that robotic-assisted spinal surgery, in relation to instrumented surgery, has already found a role in everyday neurosurgical practice.
ASJ: How has your experience been as the co-Editor-in-Chief of ASJ?
Dr. Tolias: This is a new role that I have taken and is a very exciting opportunity. I am looking forward to working with a journal to promote all aspects of surgery
ASJ: As the co-Editor-in-Chief of ASJ, what are your expectations and aspirations for the journal?
Dr. Tolias: I am hoping it will increase its profile particularly in the current environment, which is more open, based on virtual platforms but remaining robust in its peer-reviewed process and high standards.