PhD · MBBChir · FRCS(Ed) · FIMC · MRCA · FRGS
Imperial College Healthcare NHS Trust · Imperial College London
Air Ambulance Kent, Surrey and Sussex
Background
I am a Consultant Neurosurgeon at Imperial College Healthcare NHS Trust (St Mary's and Charing Cross Hospitals) and Professor of Practice (Neurosurgery) at Imperial College London, where I have established the Neurotrauma unit at St Mary's. I am also Co-Director of the Imperial Neurotrauma Centre.
In addition to my specialty interests in traumatic and hypoxic brain injury, I have clinical interests in all conditions related to intracranial pressure, including Normal Pressure Hydrocephalus (NPH), Idiopathic Intracranial Hypertension (IIH), and Hydrocephalus.
Alongside my surgical practice, I have been a practising pre-hospital care physician for 22 years — 18 years with London's Air Ambulance and 7 years with Kent Surrey & Sussex Air Ambulance, where I currently work 3 shifts per month. Pre-hospital neurosurgical emergencies — from roadside resuscitation to on-scene decision-making — sit at the heart of my clinical and research work.
My broader research interests span the full spectrum of neurotrauma and intracranial pressure physiology. I hold a PhD from UCL on the physiology of the brain at altitude and in hypoxia, and have been a researcher on expeditions to Everest, Cho Oyu, Bhutan, and the Arctic.
I co-founded GoodSAM (Good Smartphone Activated Medics), a globally deployed emergency response platform now used by 1.4 million people in the UK. What began as a tool to alert trained volunteers to cardiac arrests — tripling survival rates in clinical studies — has grown into a transformative platform across emergency services. GoodSAM now powers the NHS 111 video consultation system for England, enabling real-time triage and video-guided CPR. In the COVID-19 response, GoodSAM co-ordinated the mobilisation of 800,000 NHS volunteers — the largest single volunteer mobilisation in NHS history.
Beyond healthcare, GoodSAM is reshaping policing: working with police forces we are tripling domestic violence arrest rates by enabling rapid officer alerting and video evidence capture. The platform is also deployed by fire services in the US and internationally. GoodSAM is active across ambulance services, police, fire, mental health triage, and mass casualty co-ordination in the UK, Australia, New Zealand, USA, Canada, and beyond.
This page is intended simply to provide a little background about me and some information about the conditions I may be treating for my NHS patients. I do not do private work or medico-legal work — I simply don't have the time — so this is not a site for promoting services, and I do not appear on doctor comparison websites.
Recognition
Guidance & Resources
It is a privilege to undertake the work I do. Whether it is surgery for trauma, hydrocephalus, or raised intracranial pressure, the goal is almost always the same — to keep the person the same person they were before. Please always discuss your individual situation with your clinical team.
Traumatic brain injury (TBI) occurs when a sudden physical impact disrupts normal brain function. Injuries range from mild concussion — a temporary change in brain function — through to severe TBI involving structural damage, bleeding, or swelling within or around the brain. Our team has led the development of a new TBI classification system adopted by the Society of British Neurological Surgeons ↗.
Many patients with head injuries are found to have a chronic subdural haematoma — a collection of blood on the surface of the brain that develops gradually. If this is your diagnosis, useful patient information is available at chronicsubdural.info ↗.
The following advice is based on NICE clinical guideline CG176 (Head Injury). It is intended for patients discharged from hospital or Emergency Department following a head injury assessed as low risk.
You should rest and avoid strenuous activity for at least 24–48 hours. It is normal to experience mild headache, tiredness, difficulty concentrating, and slight dizziness in the days following a head injury — these symptoms usually resolve within two weeks.
You should NOT: drink alcohol, take sedative medications, drive a vehicle, operate machinery, or be left alone for the first 24 hours unless a responsible adult is with you.
If symptoms do not improve within two weeks, or if you develop new symptoms, please contact your GP or return to hospital.
Hydrocephalus is a condition in which cerebrospinal fluid (CSF) — the fluid that surrounds and cushions the brain and spinal cord — accumulates abnormally within the ventricles (fluid-filled cavities) of the brain, causing them to enlarge. In adults, hydrocephalus most commonly arises as a result of obstruction to CSF flow, impaired absorption of CSF, or, rarely, overproduction. Common causes in adults include previous haemorrhage (bleeding into the brain or its coverings), meningitis, head injury, tumours, and aqueductal stenosis — a narrowing of the channel connecting the third and fourth ventricles. In many cases no cause is found.
The symptoms of hydrocephalus depend on how quickly pressure builds and the underlying cause, but commonly include headache (often worse in the morning or when lying down), nausea and vomiting, visual disturbance, unsteadiness, and cognitive slowing. Urgent treatment is required when pressure is high, as untreated hydrocephalus can cause serious and permanent neurological injury.
A VP shunt is the most widely used surgical treatment for hydrocephalus. A small catheter is passed into the enlarged ventricle through a tiny hole in the skull, and connected via a pressure-regulated valve under the scalp to a second catheter that runs under the skin to the abdomen, where excess CSF drains safely into the peritoneal cavity and is reabsorbed. Surgery is performed under general anaesthetic and typically requires 2–3 days in hospital.
ETV is a minimally invasive endoscopic procedure that can be an alternative to shunting in selected patients — particularly those with obstructive hydrocephalus (where CSF flow is blocked, rather than impaired absorption). A small camera (endoscope) is passed through a tiny hole in the skull into the third ventricle, and a small opening is made in the floor of the ventricle, creating a new pathway for CSF to bypass the obstruction and flow to where it can be reabsorbed naturally. No implant is left behind.
Normal Pressure Hydrocephalus (NPH) is a condition in which cerebrospinal fluid (CSF) — the fluid that surrounds and cushions the brain and spinal cord — accumulates in the ventricles (fluid-filled spaces) of the brain, causing them to enlarge. Despite this enlargement, pressure measurements of the CSF are often within the normal range, which gives the condition its name. NPH primarily affects older adults and is characterised by a triad of symptoms.
The tap test is a key diagnostic procedure. A lumbar puncture is performed under local anaesthetic to remove approximately 30–50ml of CSF from around the lower spine. You will be assessed walking and performing cognitive tasks before and 24–48 hours after the procedure. A significant improvement in your walking suggests you are likely to respond well to a shunt operation.
If investigations suggest you are likely to respond to treatment, a ventriculoperitoneal (VP) shunt or lumboperitoneal (LP) shunt is inserted. This is a small tube that drains excess CSF from the brain to the abdominal cavity, where it is safely reabsorbed. Surgery is performed under general anaesthetic and typically requires a 2–3 day hospital stay.
Idiopathic Intracranial Hypertension (IIH) — also known as pseudotumour cerebri — is a condition in which the pressure of the CSF around the brain is persistently elevated without an obvious underlying cause such as a tumour or blockage. It predominantly affects women of childbearing age who are overweight, although it can occur in anyone. If untreated, IIH can cause permanent visual loss.
Management of IIH is individualised. Many patients improve significantly with weight loss and medical treatment. Surgical options are reserved for those who do not respond, or who have severe or rapidly deteriorating vision.
A cranioplasty is an operation to replace a section of the skull that has been removed (a procedure called a decompressive craniectomy) or lost through trauma, infection, or disease. The skull defect may be repaired using the patient's own stored bone or — more commonly — with a custom-made synthetic implant (typically titanium mesh, PEEK polymer, or hydroxyapatite cement). The operation aims to protect the brain, restore the normal appearance of the head, and can also improve neurological function.
Cranioplasty is generally well tolerated but, like any neurosurgical procedure, carries risks that will be discussed with you in detail during your consent process. The main risks include:
For 200 years, the Monro-Kellie doctrine described the skull as a rigid closed box: brain tissue, blood, and cerebrospinal fluid (CSF) share a fixed space, and an increase in any one must be compensated by a reduction in the others — or pressure rises. This elegant concept has underpinned neurosurgery and neuro-critical care ever since.
However, this traditional model treats all three components equally, which misrepresents reality. CSF is produced very slowly — about 0.35 ml per minute — while blood flows into the brain at roughly 700 ml per minute. It is the dynamic relationship between arterial inflow and venous outflow that most powerfully drives moment-to-moment changes in intracranial pressure. I proposed a revision to this doctrine — Monro-Kellie 2.0 — which re-centres the venous outflow as the dominant, often-overlooked regulator of ICP. You can read the full paper here ↗.
A striking feature of Monro-Kellie 2.0 is that a single physiological mechanism — impaired venous outflow from the brain — appears to connect several seemingly unrelated clinical conditions and environments. When venous blood cannot drain adequately, pressure backs up inside the skull even when the brain itself is structurally normal.
The practical implication of Monro-Kellie 2.0 is that many patients across conditions as varied as IIH, altitude sickness, post-TBI, and spaceflight share a common physiological problem — impaired venous drainage — that is potentially modifiable. Recognising this link guides more precise treatment: whether that is stenting a venous sinus in IIH, carefully positioning a trauma patient on the roadside, or designing protective countermeasures for astronauts.
Read: Monro-Kellie 2.0 (Wilson MH, JCBFM 2016) — Full PaperEmergency Response Platform
Good Smartphone Activated Medics — a globally deployed emergency response platform I co-founded to transform pre-hospital care.
GoodSAM bridges the gap between the emergency call and the arrival of an ambulance — alerting the nearest trained volunteer to attend, often reaching the patient in seconds. With video-guided CPR, a call handler or GoodSAM responder can direct a bystander through resuscitation in real time, dramatically improving outcomes. GoodSAM is the NHS 111 video system for England — bringing clinical triage into the home.
In policing, GoodSAM is transforming how forces respond to domestic violence, missing persons, and major incidents — enabling rapid alerting, live video evidence, and co-ordinated deployment. Working with police services we are tripling domestic violence arrest rates. The platform is also deployed by fire services across the US and internationally for rapid crew alerting and incident co-ordination.
For full clinical evidence, case studies, and partner information, visit www.goodsamapp.org — or the Australian & New Zealand evidence and case studies at goodsamapp.org/oz.
GoodSAM in action
News stories & evidence
Lectures & Media
Selected public lectures, conference presentations, and media appearances covering neurotrauma, pre-hospital care, and emergency medicine innovation.
This is something of an old public talk (from when I was young!) but the sentiment counts today as much as ever.
Academic Output
Over 100 peer-reviewed publications. First and last author work in NEJM, The Lancet, Lancet Neurology, Annals of Neurology, and JCBFM.
I am Principal Investigator on a number of collaborative clinical trials, and Chief Investigator on the NIHR-funded Spinal Immobilisation Study — www.spine.study — examining the evidence base for cervical spine immobilisation following blunt trauma.
Book
Get in Touch
For clinical referrals, please contact Imperial College Healthcare NHS Trust via the standard referral pathway. For speaking enquiries, academic collaborations, or GoodSAM partnership enquiries, please use the links below.