​Aobakwe Selebogo
 
In an age of rapid medical innovation, where technologies like advanced imaging and biomarker diagnostics are reshaping our understanding of the human brain, one challenge remains stubbornly unchanged: the measurement of raised intracranial pressure (ICP). 
According to the World Health Organisation, elevated ICP is one of the most common and dangerous symptoms in children and adults with brain pathology. Yet, the current gold standard for diagnosis still involves drilling into the skull to insert a probe - an invasive and risky procedure.
Professor Llewellyn Padayachy, a globally recognised pioneer in paediatric neurosurgery and a leading figure in the development of non- invasive techniques to detect ICP in children. His work is transforming how brain conditions are diagnosed and treated, especially in fragile young patients.
A specialist in minimally invasive neurosurgery, Professor Padayachy has earned international recognition for his contributions to the treatment of brain tumours and hydrocephalus.
Born and raised in Laudium, a township southwest of Pretoria, Padayachy's journey into medicine was anything but conventional.
"Growing up, I never envisioned myself becoming a doctor. I wanted to be a marine biologist, though I didn't know what it was called at the time. I was just fascinated by sea life," he recalls with a smile. "But I'm glad I chose otherwise."
After matriculating from Himalaya Secondary School, he studied medicine at the University of Cape Town, where he later earned his FCS (Neurosurgery) with distinction and received the prestigious Roland Krynauw Medal. He completed both his MMed and PhD at UCT, and was awarded the Hamilton Naki Scholarship, which enabled him to pursue a post-doctoral clinical fellowship at the University of Oxford. 
Today, he serves as Full Clinical Professor and Head of the Department of Neurosurgery at the University of Pretoria, and Chief Specialist and Paediatric Neurosurgeon at Steve Biko Academic Hospital.
While preparing for a five-hour surgery on a three-year-old girl with a brainstem ependymoma, Padayachy reflected on how a chance encounter during a rotation led him to paediatric neurosurgery.
"My pathway in neurosurgery has been serendipitous. Even though the challenge of this subspecialty is profound, the privilege to be involved in the care of these children is equally fulfilling.
"Paediatric neurosurgery is a world of fragile patients, anxious parents, and uncertain outcomes. You're often treating children before they even understand what's happening to them. It requires not just skill, but empathy and trust," he said.
The stakes for the young patient were high. The tumour's location near the brainstem posed serious risks to her breathing and motor function.
"We've prepared for every possibility. Given the nature of her tumour, she will need radiotherapy, but she is a strong little girl," he said.
Despite his accolades, Padayachy is candid about the systemic challenges facing paediatric neurosurgery in South Africa.
"The population is growing at a rate we can't keep up with, and we simply don't have enough paediatric neurosurgeons to meet the demand. The waitlists are long. The cases are urgent. The resources are stretched thin," he explained.
"Improving our capacity, both in terms of human resources and time, will enhance our course tremendously. But we can't wait for perfect conditions. We must make the most of what we have, use less invasive techniques, reduce recovery times, shorten hospital stays. It's about being smarter with fewer tools," added the Professor.
Now, two decades into his career, Professor Padayachy is regarded as one of the most respected names in his field. His surgical days begin before sunrise and often end long after others have gone home.
"The work is gruelling. The risks are high. But the rewards are incalculable," he said.