Department für Neurochirurgie und Neurotechnologie
Universitätsklinik für Neurochirurgie

I undertook a three-month clinical fellowship in Adult Neurosurgery at the University Hospital Tübingen, Germany, under the supervision of Professor Dr. Marcos Tatagiba. The fellowship provided an excellent opportunity to gain exposure to advanced neurosurgical practice within a highly specialized and structured clinical environment. This would not have been possible without an approval from the World Federation of Neurosurgical Societies (WFNS). I am sincerely grateful for this. 

During this period, I was actively involved in the activities of the department, including operative sessions and academic meetings. The centre operates as a high-volume neurosurgical unit, performing approximately 10–15 procedures daily. There was also a notably high patient load of vestibular schwannomas, offering valuable exposure to the evaluation and management of these complex lesions. 

The operative experience was extensive, covering a wide spectrum of procedures such as intracranial tumour resections, skull base surgeries, aneurysm clippings, arteriovenous malformation surgeries, bypass surgeries for moyamoya disease, pituitary procedures, and spinal operations for degenerative, trauma and vascular conditions. A notable aspect of the practice was the emphasis on meticulous surgical planning and execution, supported by advanced technologies including intraoperative microscopes and exoscope, neuronavigation systems, intraoperative doppler, ultrasound and neurophysiologic monitoring. The high level of precision and consistency in surgical technique was particularly instructive.

An equally valuable aspect was the consistently cordial and professional interaction with the neurosurgical team. There was open and engaging communication with the neurosurgeons before, during, and after surgical procedures, with some discussions on the peculiarities of individual cases, operative strategies, and intraoperative decision-making. This collaborative atmosphere greatly enriched the learning experience and encouraged active participation. The nursing staff and theatre personnel were also exceptionally supportive, demonstrating a high level of professionalism and teamwork while assisting in every possible way to ensure smooth operative workflow and optimal patient care.

I also participated in multidisciplinary meetings and tumor board discussions, where complex cases were reviewed collaboratively by neurosurgeons, neuroradiologists, oncologists, and other specialists. These interactions highlighted the importance of coordinated, evidence-based decision-making in modern neurosurgical care. The department’s strong academic culture, reflected in regular clinical presentations and meetings, further contributed to a stimulating learning environment. The department also hosted the 2026 European Cavernoma Meeting, which I participated in. The meeting, which brought together leading experts in the field, was highly engaging, and provided valuable perspectives on the management of cavernous malformations, while underscoring the importance of international collaboration in neurosurgery.

The fellowship further allowed me to observe important differences between neurosurgical practice in Germany and in Nigeria, particularly in terms of infrastructure, availability of advanced technology, and structured training systems. These factors contribute significantly to efficiency and optimal patient outcomes.

An important highlight during the fellowship was an invitation by Aesculap AG, for a company tour. The warm reception and professionalism was quite remarkable. It was truly inspiring to witness first-hand the precision, innovation, and commitment to excellence that define Aesculap’s work. Seeing how ideas are transformed into high-quality surgical instruments and technologies deepens my appreciation of the partnership between the industry and clinical practice. I am profoundly grateful for the scholarship and opportunity given by the company to undertake this fellowship. The investment in my training is not just an investment in an individual, but in the patients and healthcare system I serve in my country. The knowledge and exposure I have gained will have a lasting impact far beyond this visit. I appreciate the company’s generosity, vision, and commitment to advancing global neurosurgical care.

Overall, the fellowship was highly enriching. It enhanced my understanding of microsurgical techniques, improved my approach to perioperative planning, and strengthened my appreciation of multidisciplinary care. The knowledge and experience gained will contribute meaningfully to my clinical practice and teaching responsibilities at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.

Beyond the clinical environment, my stay in Germany provided a valuable cultural experience. I found the people to be courteous, organized, and respectful, qualities that were also reflected in the healthcare system. The efficiency of daily life was further exemplified by the excellent and reliable public transportation system, which greatly facilitated movement and time management. During my stay, I had the opportunity to visit a few notable locations within and outside Tübingen, offering insight into the rich cultural and historical heritage of the region. These experiences contributed to a well-rounded fellowship, enhancing not only my professional development but also my appreciation of different cultures and systems.

I am sincerely grateful to Professor Dr. Marcos Tatagiba for his superlative mentorship and to the entire neurosurgical team, including but not limited to Professor Dr Schuhmann, Dr Naros, Dr Adib, Dr Füllbier, Dr Wang and Dr Nasi at the University Hospital Tübingen for their support and openness. I really appreciate Ms Stefanie Hilcher for her cordiality, professionalism and excellent coordination of activities before and during the fellowship, ensuring that I was comfortable. 

In conclusion, this fellowship has significantly broadened my clinical perspective and reinforced my commitment to advancing neurosurgical care. It has also strengthened my motivation to contribute to the development of neurosurgery in Nigeria while fostering continued professional collaboration across institutions.

This report details the clinical activities I undertook during the WFNS-Aesculap Fellowship at the Department of Neurosurgery, University Hospital Tübingen. The fellowship, generously supported by Aesculap, aims to provide young neurosurgeons, particularly from developing countries, with comprehensive exposure to advanced neurosurgical techniques and practices. The experience was a memorable one and an absolute turning point in my young career as a neurosurgeon. I arrived in Tübingen, Germany, on April 2, 2025, via Stuttgart Airport, and was welcomed by the beautiful scenery of the Alps as our plane descended into the landing strip. The Germans I encountered were exceptionally hospitable and willing to assist with any challenges you may face as a visitor. Tübingen is a traditional university city in central Baden-Württemberg, Germany. It is a typical student community with an immaculate environment and an excellent transportation system.

The Department of Neurosurgery at the University Hospital Tübingen is a leading neurosurgical centre in Germany. It boasts state-of-the-art facilities and performs complex neurosurgical interventions across a broad spectrum of neurosurgical subspecialties. I was warmly welcomed on my first day by the departmental secretary, who gave me a tour around the facilities and introduced me to other staff members. The department comprises various subspecialties in neurosurgery, including skull base, vascular, pediatric, functional, and oncology, and is renowned for its cutting-edge research and exceptional patient care. The daily activities typically begin with morning meetings, starting at 7:15 am, during which all patients scheduled for surgery are discussed, including the emergency cases and those in intensive care. In the meetings, an in-depth analysis of the cases, including surgical approaches and decisions, was made by all staff, including senior faculty members.

The theatre session runs from Monday to Friday, and about 12-17 cases are operated daily. The theatres are equipped with advanced surgical armamentarium, including intraoperative MRI and CT scanners, the latest Karl Zeiss microscopes, various brands of endoscopes, and a robotic machine for stereotactic biopsies, among others. Patient care is evidence-based, utilizing the latest technologies to achieve excellent surgical outcomes. I observed the remarkable synergy between the various theatre staff, who aimed to achieve smooth operations and excellent outcomes. I actively participated in numerous procedures, and we typically had a brief discussion with the lead surgeon before the surgery and some debriefing at the end of the operation. Various skull base approaches, including retrosigmoid craniotomy for vestibular schwanomma and petroclival tumours, aneurysm clipping,  surgeries for intra-axial tumours, including glioblastoma and metastasis. Various spinal operations, both open and minimally invasive, were performed by the team. The outstanding aspect was the resident-centred approach, where a junior member of the team performed the initial part of the surgery, and subsequently, the senior faculty member scrubbed in to perform the more complex part of the operation.

The department also holds regular weekly academic meetings and seminars.    I attended the tumour board meetings, held on Tuesdays and Thursdays afternoons, which involve teams from various subspecialties managing patients with tumours of the craniospinal axis. In addition, the department holds monthly morbidity and mortality meetings, surgical audits, and other departmental seminars, which collectively make the training in the department robust. It is customary for international fellows to give a presentation in the department about their home countries and the peculiarities of neurosurgical practice, which I did during the latter part of my stay. 

I paid a visit to Aesculap AG in Tutlingen, which was my sponsor for the fellowship program. Aesculap AG is the largest company in Tuttlingen, Baden-Württemberg, Germany, and it manufactures medical devices and medical intervention technology. During the tour around their facilities, we were shown how various surgical instruments were produced from the raw material base to the finished product. Most notable is the production of aneurysm clips, which involves the highest level of precision and craftsmanship. Aesculap's array of products spans various therapeutic fields, including minimally invasive surgery, orthopaedic joint replacement and regenerative therapies, spinal surgery, neurosurgery, interventional vascular diagnostics and therapy, sterile goods management, as well as sutures and surgical specialities. They believe in quality production and maintaining the highest possible standard and quality assurance. 

  The department made arrangements for accommodation before my arrival, which was a short distance from the hospital, making the commute very easy. The accommodation provided was very hospitable and contained all the necessities to make my stay comfortable. I also visited some memorable tourist sites within and outside Germany. This includes the Ulm Minster, a Lutheran cathedral built in the 13th century, which was described as the tallest church in the world. I also visited the birthplace of Mozart in Salzburg, Austria, and toured the museum, which depicts the early life of Mozart and displays his first musical instruments. Additionally, I visited the residence museum in Munich, the famous Berlin Wall, and the Eiffel Tower in Paris, France. Visiting these popular and iconic sites was an unforgettable experience that allowed me to meet and make friends with other African students and tourists in Europe. 

The WFNS-Aesculap Fellowship at the Department of Neurosurgery, University Hospital Tübingen, has been an invaluable and transformative experience for me. The comprehensive clinical exposure, coupled with robust academic and research opportunities, has significantly advanced neurosurgical expertise. I want to express my profound gratitude to the World Federation of Neurosurgical Societies and Aesculap AG for their generous sponsorship and to Professor Tatagiba and the entire team at the Department of Neurosurgery for their mentorship, guidance, and unwavering support throughout the fellowship. I also want to acknowledge Ms Stefanie Hilcher for her support throughout the application process and ensuring that the fellowship went hitch-free. The knowledge and skills acquired will undoubtedly contribute to improving neurosurgical care in my country.

I am honored to present this report on my three-month fellowship in adult neurosurgery at Tübingen University Hospital, generously supported by the World Federation of Neurosurgical Societies (WFNS) and AESCULAP. I would like to sincerely thank the entire neurosurgical team at Tübingen University Hospital and the WFNS for providing me with this invaluable opportunity to learn from globally renowned neurosurgeons. This experience has been transformative, and I believe it will play a pivotal role in shaping my future career as a neurosurgeon. It has been a wonderful experience, and I believe it will greatly influence my career path as a young neurosurgeon in the profession. Neurosurgery remains a developing specialty in Kenya. My experience at Tübingen University Hospital has greatly deepened my passion for the field and renewed my commitment to pursuing excellence in surgical practice. The level of expertise, precision, and professionalism I observed from the faculty was truly inspiring. I was especially moved by the mastery exhibited in the operating theaters, and I aspire to emulate this standard in my future work.

I have a strong interest in skull base neurosurgery, and the fellowship afforded me the rare opportunity to observe a wide range of complex skull base cases. The quality of surgical care and the meticulous techniques demonstrated have strengthened my resolve to pursue subspecialty training in this area. I am eager to apply for future WFNS-sponsored skull base fellowships to advance this goal. Over the course of the fellowship, I observed more than 300 surgeries, gaining a wealth of knowledge and exposure that I will carry forward into my career.

Each day presented a new and enriching learning experience. I was especially impressed by the collegial atmosphere in the operating rooms and the professionalism of the surgical teams. The commitment to patient-centered care was evident in every aspect of clinical practice, from preoperative planning to postoperative management. I am confident that the patients at Tübingen University Hospital receive world-class neurosurgical care. 

The department, under the leadership of Professor Marcos Tatagiba (MD, PhD), is a model of excellence. His humility, dedication, and leadership deeply inspired me. My personal interactions with Prof. Tatagiba were among the most memorable aspects of the fellowship, and I am grateful for his mentorship and encouragement. I am deeply grateful for the opportunity to have interacted with such a great leader in the world of neurosurgery. 

The teaching sessions were intellectually stimulating and clinically relevant. I had the privilege of observing a broad range of surgeries – from complex spine cases to intricate cranial procedures – performed by various experts. I am particularly grateful to:

• Professor Dr. Jürgen Honegger, who introduced me to endonasal microsurgical transsphenoidal resection of pituitary tumors – a technique I had never seen before. His clear explanations and openness to teaching made this a truly enlightening experience.
• Professor Dr. Constantin Roder, whose treatment of moyamoya disease using superficial temporal artery–middle cerebral artery bypass surgery was both novel and deeply educational for me.
• Professor Dr. Martin Schuhmann, whose soft tissue dissection skills and insights into the surgical management of craniopharyngiomas and ependymomas were exemplary. His kind and patient approach to teaching was particularly appreciated.

• I would like to extend my sincere appreciation to Dr. Sasan Adib a senior consultant in the department, for his outstanding dedication and efforts in explaining complex spine surgeries with remarkable clarity and depth. His ability to break down intricate procedures into comprehensible concepts has greatly enhanced my understanding and confidence in advancing in spine surgery. Dr. Adib’s commitment to education and knowledge-sharing is truly commendable.

During my fellowship at the Department of Neurosurgery, Tübingen University Hospital, I had the privilege of closely observing and learning from Professor Dr. Martin Schuhmann, whose surgical expertise and didactic approach were both outstanding and deeply enriching. One particularly memorable case was his transcallosal transchoroidal resection of an aqueductal ependymoma, along with residual third ventricle ependymomas. He emphasized key operative principles, such as the importance of avoiding tumor seeding by minimizing irrigation during resection, and taking special care to preserve the integrity of the fornix to prevent cognitive deficits. His precise and detailed anatomical dissection served as a masterclass in ventricular surgery and was invaluable in deepening my understanding of complex intraventricular approaches.

Equally impactful was Professor Dr. Naros, whose teaching style and surgical finesse were exemplary. He provided a comprehensive step-by-step explanation of right-sided amygdalohippocampectomy for mesial temporal lobe epilepsy, ensuring a clear understanding of the rationale behind each maneuver. His surgical precision was further evident during microvascular decompression procedures for trigeminal neuralgia and in the meticulous resection of vestibular schwannomas, where he consistently demonstrated an exceptional command of microsurgical technique and anatomical detail.

Finally, working with Professor Dr. Marcos Tatagiba was a profoundly educational experience. His meticulous execution of the retrosigmoid approach to vestibular schwannoma, particularly in the semi-sitting position, was exceptional. He consistently preserved critical neurovascular structures, emphasizing anatomical respect and intraoperative patience. One key principle he instilled was the importance of preserving the superior petrosal vein when possible, in order to prevent cerebellar or even brainstem infarcts – an insight that significantly impacted my surgical judgment. His surgical precision was also evident in spinal canal decompressions, where he demonstrated thoughtful technique and an unwavering commitment to patient safety. 

For the first time in my training, I also observed peripheral nerve surgery – an area with limited exposure in my home country – which further expanded my surgical horizons.

The hospital’s infrastructure was outstanding, with multiple concurrent surgeries taking place in highly advanced operating rooms. The use of state-of-the-art equipment – including the Kinevo 900 microscope, intraoperative neuronavigation, endoscopes, and real-time imaging (CT and MRI) – greatly enhanced the surgical experience. The AESCULAP instruments, including the Rhoton microdissectors, performed flawlessly, highlighting the importance of reliable surgical tools in achieving optimal outcomes and preserving critical neurovascular structures.

Expanded Section – Skull Base Training Course and Surgical Techniques

During the dedicated skull base training course, I had the exceptional opportunity to observe numerous complex cases involving cerebellopontine angle (CPA) tumors, including vestibular schwannomas and meningiomas, each approached with individualized surgical strategies tailored to the pathology and anatomy.

One of the most striking experiences was observing the use of the semi-sitting position in the retrosigmoid approach for the resection of a T3–T4 vestibular schwannoma. This approach, rarely practiced in my region due to its associated risks – such as air embolism – was executed with remarkable precision by Professor Tatagiba and his team. The meticulous intraoperative monitoring and strict adherence to safety protocols demonstrated how this technically demanding position can be used to maximize surgical exposure while minimizing cerebellar retraction.

Despite the complexity and the inherent risks, the surgical team performed the procedure flawlessly, with no intraoperative or postoperative complications. Witnessing such a high-risk procedure executed with confidence, control, and excellent outcomes was not only educational but also deeply inspiring. It emphasized the importance of rigorous training, preoperative planning, and the value of teamwork in executing technically challenging procedures safely.

The diversity of surgical approaches to CPA tumors I observed – including the retrosigmoid and midline suboccipital sub tonsillar approaches – provided a solid foundation in skull base anatomy and surgical decision-making. These insights will significantly contribute to my future aspirations of specializing in skull base neurosurgery.

The daily morning conferences were a highlight – rigorous, case-based discussions attended by professors and residents alike, reflecting the team’s commitment to collaborative learning and patient safety.

Overall, patient care at Tübingen – from preoperative assessment to postoperative follow-up – was exemplary, and I observed a seamless, efficient system supported by highly skilled professionals at every level. My interactions with faculty, residents, nurses, and support staff were consistently warm, respectful, and enriching.

I would like to extend my deepest appreciation to Professor Dr. Marcos Tatagiba and the WFNS-AESCULAP Fellowship Committee for this life-changing opportunity. My time at Universitätsklinikum Tübingen has been a personal and professional milestone. I also wish to thank Ms. Stefanie Hilcher, the visitors’ coordinator, whose warm welcome and ongoing support made my stay smooth and comfortable.

This fellowship has reinforced my belief in the power of teamwork, dedication, and continual learning. I return to Kenya deeply inspired and better equipped to contribute to the growth of neurosurgery in my country.