Tipu Zahed Aziz was born on 9th November 1956 in Dhaka in what was then East Pakistan. He spent his childhood aspiring to and sometimes drawing on a Sancho Panza moustache whilst moving between the USA and West Pakistan to follow his father’s career as scientist. His father, Mohamed Aziz, was based at Merck and went on to lead the clinical trial of ivermectin to cure river blindness. His work was posthumously acknowledged by the winners of the 2015 Nobel Prize in Physiology or Medicine. Tipu returned to East Pakistan with his mother and siblings in the 1960s before the breakout of civil war in 1971, which led to the establishment of Bangladesh. There he developed eclectic hobbies from shooting stray dogs with his pellet gun and dissecting them in his garage to becoming an accomplished singer of Bengali classical music. The family finally moved to Oxford in 1973 during the post-war upheaval of the newly created nation.
Tipu finished his schooling in Oxford and he went on to study Physiology at University College London where highlights included seeing Andrew Huxley demonstrating axonal neurotransmission, and a chain-smoking Patrick Wall teaching gate-control theory in his laboratory. In the time when he was not studying, Tipu developed a passion for rare animal finds. He particularly enjoyed sharing a story, which involved capturing and cooking a swan with an Iranian friend in Regents Park. Tipu was allegedly busy barbecuing it for his housemates on the balcony of his nearby Great Portland Street student accommodation when the police visited.
Tipu obtained a first-class degree from UCL in 1978 and went on to study medicine as a graduate at King’s College London. House officer posts in general surgery in London, then Birmingham were followed by neurosurgery in Bristol where he first performed a radiofrequency thalamotomy for tremor with Aziz and Torrens [1]. His first registrar post was in Swansea where at interview when offered a question he asked, “why am I the only candidate?”. After Swansea, he went to Cardiff. Like many functional neurosurgeons, Tipu had been inspired from undergraduate days by his wider reading including old movies of surgery for movement disorders from the likes of Irving Cooper, Ted Hitchcock, and John Gillingham. He knew exactly what he wanted to do. However, functional neurosurgery for movement disorders had gone into hibernation in the 1980s soon after the demise of psychosurgery and with the advent of increasingly sophisticated medications for Parkinson’s disease. He explored doctoral research into resurrecting it with several British potential mentors. A morning visit to Sid Watkins at the Royal London was memorable for Sid offering him a whisky, then imparting some frank relationship advice while puffing a cigar with his feet on his desk, before finally standing to christen his office sink.
Tipu sought out Alan Crossman, a neuroanatomist in Manchester who offered him a basic scientist studentship from the UK Medical Research Council (MRC) to undertake an MD research degree lesioning the subthalamic nucleus in monkeys. Tipu moonlighted with registrar locums in Manchester Royal Infirmary and commuted from a small village near Glossop where he and his young family lived mostly off large bags of rice bought in Rusholme. The groundbreaking primate research of his doctoral thesis demonstrated the subthalamic nucleus as a new surgical target for Parkinson’s disease [2], his most cited first-author paper.
Despite discovering what would become 2 decades later the main target for deep brain stimulation (DBS) for Parkinson’s disease, Tipu’s seminal work was rejected for presentation at a Society of British Neurological Surgeons (SBNS) meeting. It was however later also published in British Journal of Neurosurgery [3]. He also struggled for a senior registrar job. Numerous interviews up and down the country resulted in rejection, perhaps because everywhere he went, he expressed his career intention to resurrect functional neurosurgery. In Cambridge, his interviewer told him he thought that functional neurosurgery was dead. “Well, I think aneurysm surgery is dead,” replied Tipu. Peter Kirkpatrick (neurovascular surgeon) got that job. Finally, at his Oxford interview Chris Adams paused, then replied, “Functional neurosurgery. No-one else here has done that for a while. You can start that again in Oxford.”
Several years of intense on-calls followed with another MRC grant and temporary consultant privileges while most of his contemporaries and some of his juniors progressed to substantive consultant posts. During this time, he formed a close collaboration with physiologist John Stein and supervised their first PhD students. He started driving to Charing Cross Hospital in West London at 4 a.m. every Friday to plan and perform radiofrequency pallidotomies and thalamotomies with neurologist Peter Bain. When he was on call for Oxford on Thursday nights, the registrar just had to cope with any early Friday morning emergency surgeries. He became a substantive consultant on a 1 day a week contract at Charing Cross in 1996 while still temporary as an MRC grant holder in Oxford. By now, he was world famous in functional neurosurgery. One day he complained to an Oxford consultant who replied tersely, “I am sure we can make you an Associate Specialist job one day.” He recounted the interaction to Chris Adams who again paused before remarking, “Very well. Tomorrow you will be a permanent consultant.” So ended in the mid-1990s a heady period of senior registrar and locum consultant life, involving bedside transorbital ventriculostomies, aneurysms clipped overnight and sent to their district general hospitals the next day, naps on the operating table between overnight cases, and even an admission to the nearby John Radcliffe for acute renal failure secondary to dehydration. Despite all this, he had passed the old general Fellowship for the Royal College of Surgeons (FRCS) at the English college and was one of the first to do the new FRCS (surgical neurology) with a huge experience, a lot of book knowledge, and a little luck. When asked by a radiologist in his oral examination to explain the physics of MRI, Tipu replied, “well I could tell you about spinning tops and electrons going up and down but I don’t really know what it all means.” He passed first time.
Remarkably in those years as senior registrar and locum academic consultant without protected academic time, his pioneering functional neurosurgery research was gaining traction. He made almost monthly visits to Boston to Eric Cosman to develop radionics image guidance and lesion generation and indulge a love of fresh lobster. A collaboration with Xiuguong Liu studying motor control, multiple papers on pallidotomy, and his first DBS cases and publications emerged. His focus shifted to discover a second target: the pedunculopontine nucleus in seminal primate experiments with DPhil students Lisa Munro-Davies and then Nandi et al. [4]. He even found time to unearth the Horsley-Clarke stereotactic frame from storage in the Science Museum (Fig. 1).
Tipu at the Science Museum with the Horsley-Clarke stereotactic apparatus, 1996.
Tipu was made professor of neurosciences at Imperial College London in 2001, 3 years before he was promoted to professor of neurosurgery at Oxford in 2004. Soon after at a Society of British Neurological Surgeons (SBNS) meeting, John Pickard asked all the neurosurgeons who held professorships to put their hands up. “Tipu why are you putting both your hands up?” asked Prof. Pickard. “Because I’ve got two,” Tipu replied beaming, one of many moments when his mischievous sense of humour would have audiences chuckling. He was also once asked to admit a patient to the Radcliffe Infirmary for a difficult lumbar puncture by a neurology consultant in reading and gave her short shrift. “I shall refer the patient to Charing Cross then,” she told him to which he replied, “please try as I am the Professor of Neurosurgery there as well!”.
As well as pioneering the seminal primate research behind the subthalamic and pedunculopontine nuclei as targets for Parkinson’s disease, early case series of lesions and DBS for movement disorders, and local field potential recordings in human movement experiments to further our understanding of the basal ganglia, Tipu developed a strong interest in neuromodulation for chronic pain. After establishing that DBS worked better in his hands than motor cortex stimulation, he went on to publish one of the largest case series worldwide of DBS for pain [5]. He started travelling annually to Porto with DM student Erlick Pereira to advise thalamic DBS for pain surgeries and drew on his experience of anterior cingulotomy for cancer pain to target the anterior cingulate cortex with DBS for the affective component of pain [6]. Blood pressure changes with periaqueductal grey DBS for chronic pain led him to investigate DBS for hypertension and orthostatic hypotension supervising MD(Res) student Alex Green [7].
His research tools were many and varied from horseradish peroxidase staining of animal brains to single photon emission tomography, magnetoencephalography, MRI diffusion-weighted tractography, and, of course, local field potentials combined with electroencephalography and electromyography of externalized DBS patients. A stream of post-doctoral scientists cut their teeth in his laboratory including Shouyan Wang, Ned Jenkinson, Niki Ray, John-Stuart Brittain, and Sandra Boccard. Numerous visiting research collaborations, clinical fellows, and professorships were accrued from functional neurosurgery units he set up as far afield as Aarhus, Kolkata, Melbourne, and Kuala Lumpur. Apart from the many fellows who became consultant functional neurosurgeons in the UK, Malaysia, Australia, and elsewhere, he was an early supporter of nurse career progression. His first movement disorders nurse specialist Carole Joint obtained a PhD in her spare time, his pain nurse specialist Liz Moir gained a Master’s degree, and several others became key opinion leaders in neuromodulation. Key to all this was Tipu’s kindness, generosity, and passion for scientific advancement. He was even quick to help Bristol beat him to the first human pedunculopontine nucleus DBS, visiting Steven Gill to program the patient together.
Tipu held numerous MRC grants and published close to 400 papers, having an H-index of 100. He was elected a Fellow of the Academy of Medical Sciences in 2012. In 2019, he was awarded the SBNS Medal (Fig. 2). In 2024, the British Society of Stereotactic and Functional Neurosurgery named its lifetime achievement medal after him and awarded the first one to him (Fig. 3). His sheer breadth of research in functional neurosurgery attracted giants of experimental neurology Peter Brown from Queen Square and biomedical engineering Tim Denison from Medtronic to Oxford to cement his legacy. Alongside this, he campaigned for and engaged in public debate about animal research, particularly the bipedal non-human primate model for movement disorders, at some risk to his personal safety [8]. One convicted animal rights activist was arrested with bomb making equipment and a map to Tipu’s house. When asked whether he was worried about this, Tipu mused that “you haven’t made it unless you have received death threats.”
Tipu Zahed Aziz receiving the Society of British Neurological Surgeons Medal, with (from left) Peter Hutchinson, John Pickard, and Alex Green in 2019.
Tipu Zahed Aziz receiving the Society of British Neurological Surgeons Medal, with (from left) Peter Hutchinson, John Pickard, and Alex Green in 2019.
British Society of Stereotactic and Functional Neurosurgery Tipu Z. Aziz Medal, awarded to Tipu in 2024.
British Society of Stereotactic and Functional Neurosurgery Tipu Z. Aziz Medal, awarded to Tipu in 2024.
Most neurosurgeons will remember a friendly, eccentrically dressed man outside the conference hall or hospital with either an espresso or a glass of white wine in one hand and a cigarette in the other. If the opportunity arose, he would smoke with patients before surgery. Accompanying the lifelong moustache, he wore a bowtie from his medical school years. The blue blazer covered with badges from the registrar years was upgraded to a black leather jacket in the consultant years with the bowtie worn again in the early professor years, for television interviews, for documentaries about him, and for meeting the Queen (Fig. 4).
Tipu presenting to Queen Elizabeth II in 2007, with Richard Kerr in attendance.
Those of us who had the privilege to join Tipu’s inner circle of academic neurosurgery trainees will not only cherish the numerous international prizes his group won and the trips we had but forever remember the good food, wine, whisky, company, and the stories generating sheer belly laughter and reflux from a life steeped in both neurosurgery and functional neurosurgery. There was the time Hirotaro Narabayashi invited him to sit outside in the pouring rain to eat steak together in silence; the time he used a series of eggs to calibrate a completely unknown radiofrequency lesion generator just before surgery in Karachi; the time he carted a patient with their head in a stereotactic frame across Kolkata using various modes of public transport from a broken CT to a working one in a rival hospital. Then there was the time he ran over a muntjac that he dragged into the back of his Land Rover, then butchered, and curried for various registrars; the time he brought two roast baby pigs from Portugal back to his fridge after removing all its shelves, hacking chunks off them for a fortnight until they no longer smelt edible. He loved cooking for his research registrars and talking about the science and the surgeries over a good meal. He was once stopped at airport security because he forgot that he had bought a large meat cleaver at a Shanghai market and left it in his hand luggage.
Tipu Aziz was a giant of functional neurosurgery (Fig. 5), a first-generation immigrant who, despite various career cul-de-sacs, climbed the ziggurat to reach the pinnacles of British neurosurgery and British neuroscience by sheer brilliance, hard work, and persistence. His “Aziz” technique of twist drill bilateral DBS or unilateral lesioning sometimes completed in 20 min from scalp incision to closure was legendary and astonished numerous international visitors (Fig. 6). He was the doyen of keeping things simple and down to earth, commensurate with his humble character. As he once said, “I am not a glory hound.” Unusually for an Oxford professor and consultant surgeon, he often also said, “just call me Tipu.”
Giants of functional neurosurgery together in 1994: Ronald Tasker, Tipu Zahed Aziz, and Philip Gildenberg (from left).
Giants of functional neurosurgery together in 1994: Ronald Tasker, Tipu Zahed Aziz, and Philip Gildenberg (from left).
He was one of very few pioneers worldwide who not only resurrected the subspecialty but whose research profoundly influenced the most common DBS and lesion operations we do today for movement disorders and pain. He was a pinball wizard of functional neurosurgery mentored by a bygone Mad Men era of gentlemen: chain-smoking, heavy-drinking workaholics whose nonchalant bravado, “can-do” attitude, love of mischief, merriment, and well-placed profanity he exemplified.
Beyond neurosurgery, Tipu enjoyed exotic cuisine (especially barnacles, Portuguese pig heads, and Iranian sheep heads), microlight flying, spotting military planes, and rock music. Who can forget his loud Meat Loaf and Chemical Brothers sets in the operating theatre? He was a voracious reader and collector of rare books with an encyclopaedic knowledge and passion for history [9, 10]. He combined all this with a wit as sharp as his tenotome. “There goes shifting dullness,” he would joke over his espresso and cigarette just outside the hospital, upon seeing one particular colleague he had nicknamed.
Tipu’s final 3 years were blighted by a head injury from which he made a remarkable recovery. He then had a short battle with oesophageal cancer, to which he succumbed on 25 October 2024. His wife Jocelyn and daughter Laila were the lucky recipients of his great humour and generosity.
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