Derriford versus Southampton

Research agent report, 4 September 2026, from published records. Gaps marked. No prognosis figures.

1. Designation and MDT

Both trusts are NHS England designated adult neurosurgery providers under service specification 1711, which lists Skull Base Surgery as one of eight major specialist activities and requires low-volume procedures to be concentrated in the smallest number of surgeons possible (often 2). No separate NHS England skull base or chordoma service specification exists and there is no named list of designated skull base centres. https://www.engage.england.nhs.uk/consultation/adult-neurosurgery/user_uploads/neurosurgery-service-specification-consultation.pdf
Plymouth: patient leaflets describe a skull base MDT of at least 3 neurosurgeons, 2 ENT consultants, 3 oncologists, radiologist, histopathologist, specialist nurse (Tracy Mason, 01752 433239). https://www.plymouthhospitals.nhs.uk/display-pil/pil-acoustic-neuroma-vestibular-schwannoma--5871/ Neuro-oncology MDT weekly on Thursdays. https://www.plymouthhospitals.nhs.uk/neuroscience-mdt/ Catchment Devon, Cornwall, Isles of Scilly, part of Somerset. https://www.plymouthhospitals.nhs.uk/neurosurgery/
Southampton: lists skull base and pituitary surgery as a subspecialty, catchment about 3 million. https://www.uhs.nhs.uk/departments/brain-spine-and-nerves/wessex-neurological-centre Mr Emad Shenouda chairs the skull base MDT. https://www.spirehealthcare.com/consultant-profiles/mr-emad-shenouda-c4767932/ Southampton hosted the British Skull Base Society meeting in 2011; Plymouth never has. https://skullbase.co.uk/pages/history-of-bsbs

Correction, 5 Sep 2026 (noted here 12 Oct): the neurosurgery registrar told the family Mr Shenouda is no longer at UHS. The website was out of date; ask who chairs the skull base MDT now. - National: since 1 April 2026 there is a National Chordoma and Chondrosarcoma Skull Base MDT, hosted by Northern Care Alliance (Manchester), co-chaired by Prof Omar Pathmanaban and Dr Gillian Whitfield, fortnightly, referrals via the proton beam therapy portal. Neither Plymouth nor Southampton is named as a surgical centre; any unit can refer. https://www.ncaresearch.org.uk/news/national-chordoma-chondrosarcoma-skull-base-mdt/ Chordoma Foundation UK page names only this MDT. https://www.chordomafoundation.org/united-kingdom/ - Not found: either trust on any chordoma charity centre list (Chordoma UK names only Queen Square). https://chordoma-uk.org/diagnosis-and-treatment https://dbwcharity.org/support/where-chordoma-treated/

2. Published surgical series

Plymouth: no published chordoma or cavernous sinus series. Khalil/Stavrakas/Muquit output is case reports and technique papers: clival mucocele (Ear Nose Throat J 2021, https://journals.sagepub.com/doi/full/10.1177/01455613211021176); nasoseptal flap reconstruction (Ann R Coll Surg Engl 2026, PMID 40272174); edited textbook Rhinology and Anterior Skull Base Surgery (Springer 2021) with a case-based clival chordoma chapter, not a series. https://api.crossref.org/works/10.1007/978-3-030-66865-5_32 A search-engine summary attributing a 12-patient clival chordoma series to Plymouth is wrong; that is Alexandria, Egypt (Youssef et al. 2024). https://api.crossref.org/works/10.1186/s43163-024-00594-5
Southampton: no chordoma series. One case report (Bulters, Webb, Shenouda, Br J Oral Maxillofac Surg 2010, PMID 19733943). Gallagher et al., Br J Neurosurg 2014, PMID 24559122: 151 endoscopic endonasal skull base patients, nasal morbidity only.
Both contributed to CRANIAL (30 UK/Irish centres, 866 patients; CSF leak 3.9 percent transsphenoidal, 7.1 percent expanded endonasal), per-centre results not published. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1049627/full
National chordoma cohort (Glancz et al., BMJ Oncology 2024, PMID 39886144): 230 patients referred from 18 UK units to the PBT panel 2017 to 2022; 75 treated at the Christie analysed; gross total resection 38.6 percent overall (58 percent chordoma, 17 percent chondrosarcoma); each additional case per unit accepted for PBT raised the odds of GTR by 32 percent; unit volume the only significant predictor. Units anonymised. https://pmc.ncbi.nlm.nih.gov/articles/PMC11347697/

3. Named surgeons

Plymouth: Mr Samiul Muquit (lead for pituitary and skull base surgery, core skull base MDT member, Walton Centre fellowship) https://www.plymouthhospitals.nhs.uk/muquit-mr-s; ENT Prof Hisham Khalil https://www.plymouthhospitals.nhs.uk/khalil and Mr Marios Stavrakas https://www.plymouthhospitals.nhs.uk/stavrakas-m.
Southampton: Mr Emad Shenouda (skull base MDT chair; profile emphasises spinal volume) https://www.uhs.nhs.uk/for-patients/find-your-consultant/mr-emad-shenouda; Mr N Mathad (pituitary/endonasal; Bulters is neurovascular, corrected 4 Sep, see thread 09); 16 consultants. https://www.uhs.nhs.uk/departments/brain-spine-and-nerves/wessex-neurological-centre/neurosurgery ENT Prof Rami Salib. https://www.uhs.nhs.uk/for-patients/find-your-consultant/mr-rami-j-salib
Not found: annual skull base or chordoma case volumes for either unit.

4. CQC and GIRFT

Derriford: overall Requires Improvement (27 Feb 2026); Surgery Good (Aug 2025). https://www.cqc.org.uk/location/RK950
Southampton General: overall Requires Improvement (21 Jul 2023); Surgery Good (June 2017). https://www.cqc.org.uk/location/RHM01
GIRFT cranial neurosurgery 2018: names chordoma as a rare tumour better served by a regional model with fewer higher-volume centres. No unit-level skull base data. https://gettingitrightfirsttime.co.uk/wp-content/uploads/2018/05/CranialNeurosurgeryJune18-L.pdf

5. Proton pathway

Referral by a consultant clinical oncologist via the national PBT portal; Christie and UCLH operate as one national service; the referring unit does not choose the centre. https://www.christie.nhs.uk/your-treatment-and-care/services/proton-beam-therapy/proton-beam-therapy-faqs https://www.england.nhs.uk/commissioning/spec-services/highly-spec-services/pbt/

6. Geography

Truro to Derriford: 54 miles, about 1h07 by car. Truro to Southampton General: about 190 miles, 3h41 by car, 5h29 by rail. Derriford is the designated neurosurgery centre for Cornwall.

Bottom line

No published evidence that either unit has a better track record for skull base chordoma or chondrosarcoma: neither has published a chordoma series or outcome figures, and both are anonymous contributors to the same national datasets. Both are designated neurosurgery providers with a skull base MDT and an ENT-neurosurgery endonasal pair. The evidence-backed decisive factors are unit volume (GTR tracks volume; GIRFT recommends regionalising chordoma), the new national chordoma MDT (either unit can and should refer), and the proton pathway (identical). Southampton has the longer skull base pedigree but no published proof of better chordoma outcomes; Plymouth is three hours closer and the default regional centre. Ask each unit how many skull base chordomas and chondrosarcomas they operate on per year and how many they have referred for protons since 2017, and insist the case goes to the national chordoma MDT whichever unit holds it.

Research thread 07 · source file em-research/07-derriford-vs-southampton.md · last edited 12 October 2026