Neurosurgery is a discipline of medicine and that specialty of surgery which provides the operative and non-operative management (i.e. critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis; and the operation and non-operative treatment of pain. As such, Neurosurgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and the skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
The Neurosurgical services are provided by the Division of the Neurosurgery of the Department of Surgery of the Chinese University of Hong Kong (CUHK), the Prince of Wales Hospital (PWH) and the Northern District Hospital (NDH). The medical staffs consists of academic staff (employed by the CUHK) and the non-academic staff (employed by Hospital Authority of Hong Kong). The Division works as a single unit under the leadership of Professor in Neurosurgery of CUHK.
Currently, the academic staff included a professor and an associate professor in Neurosurgery. There are a number of experienced neurosurgeons serves as adjunct associate professors for teaching of the undergraduate medical students and post-graduate neurosurgical trainees.
Our mission is to serve the public with high quality services, improves the neurosurgical development with research and to educate the medical student and surgical trainee on the specialty of neurosurgery.
The main activities are conducted in three hospitals and their outpatient clinics: the Prince of Wales Hospital (PWH), the Nothern District Hospital (NDH) and the Shatin Hospital (SH). The PWH is the teaching hospital of the CUHK. It serves as secondary for the East New Territory region that has a population of 1.2 million and tertiary referral center for patient from all regions of Hong Kong. The NDH is a major district hospital serving the North New Territory. NDH serves a population of 0.5 million. Both PWH and NDH have 24-hour CT scan services, emergency operation theatre for neurosurgical operation and on-site neurologist for consultation of neurological problems. In addition, the PWH also have neuronavigation facility, and radiosurgery facility. SH is our rehabilitation hospital. It has a comprehensive rehabilitation team (including physiotherapist, occupational therapist, speech therapist, and medical social workers etc.) and facility for both neurosurgical in-patient and a day hospital. SH also have infirmary beds and mid-way house to facilitate the return of patient back to the society. Our medical staff serves directly in the above hospitals to management the acute and rehabilitation care of the neurosurgical patients.
There are 35 adult acute neurosurgical beds, 3 neurosurgical high dependence beds and a float number of peadiatric neurosurgical beds and intensive care beds as required in PWH. The neurosurgical beds are concentrated and managed by a team of nurse trained in neurosurgical nursing. There are on average 60 neurosurgical patients in the SH. There is a floating number of neurosurgical beds in NDH.
There are 8 consultation rooms and 3 sessions in the neurosurgical outpatient clinic per week in the Li Ka Shing specialist clinic (attached to Prince of Wales Hospital). There is another neurosurgical outpatient session in NDH.
There are 7 elective operation list per week (6 are general anaesthesia and 1 for local anaesthesia) in PWH, 4 elective operative list (3 are general anaesthesia and 1 is local anaesthesia) in NDH, and unlimited emergency operation list in PWH and NDH.
Operating microscopes are available in both hospitals.
In PWH, we have an anesthetist specialized in neuro-anaesthesia, Prof. Matthew Tak-vai CHAN (Professor of the Department of Anaesthesia and Intensive Care CUHK)
Endovascular neurosurgery facilities
There is a session for endovascular neurosurgery under general anaesthesia per week In PWH and there is unlimited number of session for endovascular neurosurgery under local anaesthesia. The procedure is performed with digital subtraction angiography (DSA). The procedure is performed by a team consist of intervention radiologist and neurosurgeon. Dr. Simon YU (Adjunct Associate Professor of the Department of Diagnostic Radiology and Organ Imaging, CUHK) and Dr. George Wong are dedicated for the procedures.
PWH has one of the most sophisticated linear accelerated-based conformal radiosurgery facilities. The computer-controlled micro-multi-leaflet collimator (mMLC) provides high precision conformal radiation delivery. Radiosurgery is performed once or twice a week. The case selection, treatment planning and follow-up are conducted with collaboration between radiotherapist and neurosurgeons with training in radiosurgery. Dr. Samuel Kwok-wing CHIU (Adjunct Associate Professor of the Department of Clinical Oncology, CUHK) and Dr. Wing-Hong KWAN (Consultant Oncologist) are both sub-specialized in the field of radiosurgery.
There are three senior neurologists in PWH and two neurologists in NDH providing the neurology services. Special stroke unit, electrodiagnostic units, video-EEG facilities are available for comprehensive work-up of neurosurgical patients.
There is combine pain clinic conducted by the neurosurgeon and the anesthetist with special interest in pain management. After evaluation of the patient in the outpatient clinic, some patient (around 3 per week) will be admitted to the neurosurgical ward for intervention procedures. This provides a good opportunity for neurosurgical trainee to learn about pain management.
Pituitary tumour services
There is a combine pituitary clinic conducted by the endocrinologist and neurosurgeon for perioperative evaluation of the endocrine function, for selection of patient for surgery the alternative management. The endocrinologists are led by Professor Clive COCKRAM (Professor of Endocrinology, Department of Medicine, CUHK).
There is extensive collaboration between the Division of ENT and Neurosurgery in the assessment, work-up and operation for patient with acoustic neuroma. The division of ENT and the associated audiology services provides the screening of patients with hearing loss and assessment of patients with acoustic neuroma. When appropriate, excision of acoustic neuroma through the trans-labyrinthine approach is performed by both the ENT surgeon and the neurosurgeon. The ENT surgeons with special interest in neuro-otology include Prof. C. Andrew VAN HASSELT (Professor of Otorhinnolaryngoloy, Department of Otorhinolaryngology, Head and Neck Surgery, CUHK) and Dr. Michael CF TONG (Consultant ENT surgeon, UCH). We had also pioneered in the providence of auditory brain sten inplant in Asia.
Neuro-rehabilitation facilities are available in the Shatin Hospital. There is a team of rehabilitation therapist in SH. Weekly rehabilitation conferences are conducted in SH with the active participation of our neurosurgical staffs. The management of patient in SH is directly under our care.
The Division of Neurosurgery is active in researches in various areas of neurosurgery. The results were published in renowned international journals including Journal of Neurosurgery, Neurosurgery, and Stroke. Current research project includes the use of microdialysis in head injury, impact of telemedicine on neurosurgical service delivery, rat model for contusional head injury, and cerebral haemodynamic of patients with carotid stenosis etc.
There is regular academic meeting in the Division. The meetings include mortality and mobidity meeting, neuroradiology meeting, neuropathology conference, neurooncology meeting, combine neurology-neurosurgery-neuroradiology teaching, departmental research meetings, and grand rounds etc.
The division of neurosurgery provides training of basic surgical skills for basic surgical trainees. The training is recognized by the College of Surgeons of Hong Kong and the Academy of Medicine of Hong Kong. Basic surgical trainees may attach to our Division for a period of 6 to 12 months. The trainees are provided with education on the basic management of neurosurgical patient, interpretation and understanding of basic neuro-imaging. The trainee should participate in at least 50 neurosurgical operations in a six-month period. During the training, it is expected that the trainee will be able to perform simple operations such as burrholes for ventricular drain insertion, muscle biopsy and tracheotomy.
The Division of neurosurgery is accredited by the College of Surgeons of Hong Kong and the Academy of Medicine of Hong Kong for training of higher surgical trainee specialized in neurosurgery.
All candidates must fulfill the following requirement in addition to the training in basic surgical skills required by the College of Surgeons of Hong Kong for accreditation of intermediate degree.
Each residence must complete a minimum of sixty (60) months of training in neurosurgical. A minimum of 6 months and a maximum of 12 months of the neurosurgical training should be before the passing of the entry examination for higher neurosurgical training (i.e. FRCS, AFRCS (Edinburgh) or equivalent degree). Hence, a minimum of 48 months of neurosurgical training is needed before qualifying for the exit examination leading to the accreditation of the degree of Fellowship of the Hong Kong Academy of Medicine (FHKAM).
The training is conducted in modular format and a general guideline on the progression of training over different years of training which includes (A) General neurosurgical management, (B) Operative neurosurgery, (C) Neuroradiology and Pathology, (D) Neuro-critical care and applied neurophysiology.
The modules includes (I) Adult neurosurgery, (II) Neuro-critical care and peadiatric neurosurgery, (III) general neurosurgery in a district hospital, (IV) overseas neurosurgical training.
Section A [2003-2008]
Section B [1997-2002]