Basically, neurosurgery practice started after 1950. After the Korean War, the central government organized the first 1-year training course in neurosurgery in 1955 in Beijing. The trainers were Dr. Zhao Yicheng and former Soviet Union neurosurgeon Dr. Artuinov. After the training course, the trainees returned to their hospitals to develop neurosurgery. Dr. Wang Zhongcheng was one of the trainees. Because of politics, prejudice, and unfair international sanctions, gaining modern knowledge of science and techniques was very difficult for the Chinese people, including medical service, and neurosurgery is not an exception. Although the resources of medicine were very limited, Chinese neurosurgeons continued their mission with hard work, collecting the knowledge from daily clinics and research. During that time, Cerebral Vascular Angiogram was finished by Dr. Wang Zhongcheng in 1965, the microscope was first used in neurosurgery in 1970, and the Textbook of Neurosurgery was published in 1980s.
In 1985, the Chinese Neurosurgical Society of the Chinese Medical Association, the first and largest national organization of neurosurgery in China, was founded in Beijing. Dr. Wang Zhongcheng was elected to be the president until 2004.
Dr. Wang Zhongcheng, Icon of Neurosurgery in China
Dr. Wang Zhongcheng was born in December 1925 in Shangdong Province, China, and obtained his medical education at Medical School of Peking University from 1944 to 1950. His decision to become a neurosurgeon came during his service in the Korean War after he witnessed a youth die from head injuries. After attending the first training course at Beijing Tongren Hospital in 1955, he was nominated to organize a department of neurosurgery in China that was separated from the department of surgery and neurology. In 1958, after Beijing Xuanwu Hospital was founded, Dr. Wang brought his neurosurgical team to Xuanwu Hospital. Two years later, the Beijing Neurosurgical Institution was founded, where Dr. Wang continues to serve as director today. Like his contemporaries, Dr. Wang was passionate about his career. Despite international sanctions on the exchange of knowledge and techniques, and with no protection from radiation exposure, Dr. Wang and his assistants practiced cerebral vascular angiograms on cadavers from 1954 to 1958. Their work was published in the book Cerebral Vascular Angiogram in 1965. For this achievement, Dr. Wang experienced life-threatening pneumonia twice due to leukocytopenia, and even now, his white blood cell count is only half what is normal. He subsequently published Brain Injury, Spinal Cord Disease, and Intracranial Tumors. These works helped Chinese neurosurgeons to achieve a better understanding of neurosurgery. In 1985, he established the Chinese Journal of Neurosurgery so that neurosurgery papers no longer had to be published in journals of surgery or neurology. His clinical practice was often said to be the first in China. He performed the first microscopic resection of a pituitary adenoma in 1976 and the first anastomosis of the occipital artery with the posterior inferior cerebellar artery in 1978. Dr. Wang was also the first to resect a 9-cm intracranial aneurysm without thrombosis.
In addition to his devotion to clinical practice, Dr. Wang also had great passion for research, often combining clinical and basic science research. He always found a way to improve current procedures, and he catalyzed much growth in Chinese neurosurgery. Because of his contributions, he was awarded China’s 2008 State Top Scientific and Technological Awards. Only 20 scientists have been bestowed this honor since its foundation in 2000. Dr. Wang always emphasized the importance of continuing medical education in neurosurgery; even in the 1950s, he had started to organize neurosurgical training courses. By 2000, almost one-third of Chinese neurosurgeons had attended his training courses or listened to his lectures.
Neurosurgery Center of Beijing Tiantan Hospital
In 1982, after 30 years of hard work, Dr. Wang Zhongcheng, a principal pioneer of neurosurgery in China, founded the Beijing Tiantan Hospital for the purpose of establishing a full range Department of Neurosurgery. It is a nonprofit hospital. Initially, neurosurgery was divided into several specialties, including supratentorial tumor, infratentorial tumor, cerebrovascular diseases, functional diseases, pediatrics, trauma, and spine. Thereafter, some other specialties were set up, such as the skull base and brainstem division in 1992, craniofacial communicating disease center in 2002, endoscopy unit in 2003, and glioma treatment center in 2006.
Clinicians and scientists in the departments of neurosurgery, neuroradiology, neuropathology, and the Brain Research Institute work together toward the discovery and cure the diseases of the central nervous system. It is also the most important neurosurgical training center for neurosurgery in China. In 2014, a total of 10,417 surgeries were performed.
The Division of Neurosurgery carries a continuing commitment to provide excellence in leadership in the major disciplines of neurosurgery in the full range of adult and pediatric neurological surgery specialty services. Neurosurgical Centers of Excellence have been established in the areas of brain tumors (brainstem and skull base tumor, glioma, meningioma, pituitary adenoma), cerebrovascular diseases, pediatric neurosurgery, stereotactic and functional neurosurgery, epilepsy surgery, spinal tumor surgery, and brain injury. The annual number of brain surgeries increased continuously, exceeding 7000 after 2005. The annual number of outpatient clinic visits is more than 130,000. The faculty consists of 52 full-time senior professors covering the full range of neurosurgical clinical practice and basic research. Additionally, about 30 and 40 junior consultants and about 50 residents have joined the service.
Divisions of Neurosurgery
Brainstem and Skull Base Tumor Subdivision
The first skull base and brainstem diseases subspecialty in Chinese neurosurgery was established in 1992 by Dr. Wang Zhongcheng. Later, Dr. Zhang Junting, under the instruction and guidance of Dr. Wang, started to explore this field, once regarded as a no-man’s land in China. Many intra-brainstem tumors that were once deemed inoperable, such as cavernous malformations,hemangioblastomas , ependymomas, ganglial gliomas, had been surgically treated with favorable outcomes. With an ever-expanding knowledge of skull base tumor microanatomy and physiology, intraoperative electrophysiology monitoring, and multidisciplinary cooperation, the outcome of skull base tumors has improved greatly. The anatomic preservation rate of the facial nerve in giant acoustic neuromas has reached 98%, with a total resection rate of 93%. Yearly, hundreds of meningiomas invading the cavernous sinus, medial sphenoid ridge, clivus, postpetrous, and foramen magnum are successfully resected. A total of 477 cases of petroclival meningiomas were surgically treated between 1993 and 2008. Additionally, more than 100 cases of foramen meningiomas were managed in this unit with favorable outcome. Trigeminal neuromas, chordomas, chondrosarcomas, and many other skull base tumors are also successfully treated. Although, currently, brainstem glioma treatment has been less successful, Dr. Zhang Liwei, co-director of the subdivision, is untiringly seeking better solutions through clinical and basic science research. He is leading the national program in treatment and collaboration with international researchers.
Contributions in skull base and brainstem diseases are the main achievements for the 2008 State Top Scientific and Technological Awards. Ever-growing knowledge and advances in technique with neuronavigation, electrophysiological monitoring, and endoscopes are continuing to improve the outcome of patients. Minimally invasive skull base neurosurgery has been carried out in practice.
Every year, the national training course will be hosted in spring and autumn, including hands-on cadaver dissection and live surgery observation. Every 2 years, the national skull base symposium will be hosted. In the past 2 years, multidisciplinary specialties collaborations have been carried out, including ear-nose-throat, craniomaxillofacial, plastic surgery, head and neck, and ophthalmologic symposiums.
Cerebrovascular Diseases Subdivision
Cerebral vascular diseases subdivision of Beijing Tiantan Hospital is the largest in China. Annually, more than 300 cases of aneurysms and arteriovenous malformations are surgically clipped or resected, with very low morbidity and < 1.5% mortality. Additionally, Moyamoya diseases, cavernous malformations, and internal carotid artery stenoses are treated surgically. The vascular surgeons cooperate with neuroendovascular physicians to treat complicated cases of aneurysms and arteriovenous malformations, and they often regard the patient’s best interest as their only priority. For intraoperative angiograms, digital subtraction and indocyanine green angiography are used routinely.
In addition to skillful hands, Dr. Zhao Jizong, Senior Professor of Cerebrovascular Disease and Chairman of the Department of Neurosurgery of Capital Medical University, is the current President of the Chinese Neurosurgical Society. With his effort to improve understanding of minimally invasive neurosurgery, Chinese neurosurgery entered the era of minimal invasiveness. Additionally, he led Chinese neurosurgery to participate in the international neurosurgery community. Annually, training courses in cerebrovascular disease are hosted in Beijing Tiantan Hospital.
Pediatric Neurosurgery Subdivision
The Pediatric Neurosurgery Subdivision of Beijing Tiantan Hospital is the first and one of only a few neurosurgical divisions for children in China. It has 4 senior professors, including Dr. Luo Shiqi, principal founder of pediatric neurosurgery in China. He followed the instruction of Dr. Bai Guangming, and devoted himself to pediatric neurosurgery. He has published textbooks of pediatric neurosurgery.
Annually, 600 to 700 operations are performed to resect all types of brain and spinal tumors in children. For cases of craniopharyngioma, gross total resection is achieved in many, and long-term favorable outcome in most. For medulloblastoma, the combination of chemotherapy and radiotherapy after surgery leads to 68% 5-year survival. Surgeries using the transcallosal- transfornixial approach have been performed for more than 500 patients with intra-third ventricle tumors (craniopharyngiomas, teratomas, and gliomas in the anterior, middle, or posterior regions) with excellent tumor resection results and postoperative quality of life. Tang et al. reported that the combination of radiotherapy and chemotherapy provides excellent tumor control in both short-term and long-term treatment of germinomas. This center has the largest series of hypothalamic harmatomas, including 343 cases up to 2010. In addition to advanced surgical techniques, the center also focuses on neuropsychiatry and developmental intervention.
Glioma Treatment Subdivision
Comprehensive treatments are used in the treatment of gliomas. Surgery, radiotherapy, chemotherapy, and immunotherapy are carried out for select patients. Intraoperative awake brain mapping has been employed since 2007.Although the treatment of malignant tumors such as multiform glioblastomas has undergone some advancement, it still poses a big challenge. Yearly, more than 700 patients receive treatment in this division. According to the tumor molecular pathological characteristics, patients received chemotherapy and radiotherapy following the international protocol. Some research and clinical trials are ongoing to seek optimal protocols.
Functional and Epilepsy Subdivision
Since the foundation of Beijing Tiantan Hospital in the 1950s, the functional neurosurgery division has been established. Neurosurgeons, neurologists, and neuroelectrophysiologists work together to offer suitable management for patients. Surgeries to treat movement disorders such as Parkinson’s disease and epilepsy have been conducted for more than 20 years. Beijing Tiantan Hospital is the first institution in China to use deep brain stimulators in Parkinson’s disease and has the largest volume of these procedures in the country. Currently, deep brain stimulators are implanted unilaterally or bilaterally in about 100 cases each year. Hundreds of refractory epilepsy cases are cured through surgical approaches. Functional neurosurgery grew significantly during the past decade, and this trend will continue in the future.
Brain Injury Subdivision
Yearly, about 900 brain injury cases are transferred to this unit, especially severe patients. The use of hypothermia, intracranial pressure monitoring, and many other resources are employed to resuscitate patients. Mortality and severe morbidity have decreased to a reasonable level. Almost 10 years ago, many patients were transferred from local hospitals that were unable to provide adequate medical care. However, this number has dropped because of improvements in local care. Surgeons at Beijing Tiantan Hospital use computer-assisted placement of 3-dimensionally-shaped titanium-alloy plates to fix skull defects with improvement in cosmesis and neurological symptoms.
Pituitary Adenoma Treatment Subdivision
Annually, more than 500 patients undergo surgical resection and more than 5,000 visit the outpatient clinic. Individualized plans, including surgery, chemotherapy, and radiotherapy, are offered according to the tumor subtype and the patients’ need. Collaboration between neurosurgeons and endocrine physicians has been set up for better outcome of patients.
Supratentorial Tumor Subdivision
The supratentorial tumor subdivision provides comprehensive treatment services for supratentorial tumors and lesions, including meningiomas, gliomas, and craniopharyngiomas. Neuropsychiatry and neurological function assessment are used before and after surgical intervention because the quality of life of the patients is most important decisive factor for treatment protocol. Annually, about 800 patients receive surgical management.
Neuroendoscopy is used widely in the resection of pituitary adenomas, suprasellar and intraventricular cysts, and hydrocephalus treatment. More than 1,500 patients have received this minimally invasive service in the past 10 years.
Spinal Tumor Subdivision
Operations to remove intramedullary tumors, such as ependymomas and astrocytomas, and extramedullary tumors, such as neurofibromas and meningiomas, are the main tasks of this unit. Yearly, more than 400 cases of tumors undergo resection. Additionally, some craniocervical junction malformations, such as Chiari malformations, are treated surgically. The degenerative diseases are very small part of the job, less than 5%, which is quite different from the United States.
Neurovascular Intervention Unit
Since the founding of neurovascular intervention unit in the 1980s, it has been the most famous neurovascular intervention unit in China. Currently, about 1,000 patients undergo interventional diagnosis and treatment each year. (In 2010, 1,187 patients underwent intervention, including aneurysms in 320 patients.) In addition to the embolization of aneurysms, vascular malformations, and fistulas, it also uses stents for ischemic stroke.
Gamma knife radiosurgery (GKR) has been applied since 1994. In the past 5 years, more than 1,000 patients have undergone GKR annually. The procedure shows excellent tumor control in pituitary adenomas, acoustic neuromas, skull base meningiomas, and brain metastatic tumors. In 2010, 151 patients with vascular malformations, 507 patients with benign tumors, 394 with malignant tumors, 1052 in total received GKR, and almost 5,000 received follow-up. Conventional radiotherapy (linear accelerator radiotherapy) is also available at this center. Germinoma and medulloblastoma patients receive a combination of radiotherapy and chemotherapy.
Branches and Collaborative Centers
Like the imbalance of economic development in China, the development of neurosurgery varied greatly throughout the nation. In an effort to provide high quality medical services for people in less developed areas, Beijing Tiantan Hospital has established two clinical branches in Beijing and 10 collaborative neurosurgical centers scattered throughout the country. These centers allow more than 1500 patients each year to benefit from the expertise of Tiantan’s neurosurgical faculty while being treated in the comfort and convenience of a local hospital. These outreach efforts also promote the advancement of neurosurgical technique in local hospitals.
Facilities that Directly Support the Neurosurgical Center of Excellence
Operating Rooms Operating rooms, newly rebuilt in 2003, accommodate 15 high-quality units for neurosurgery, equipped with high-tech information technology instruments. Intraoperative electrophysiological monitoring is routine for skull base, intramedullary, and epilepsy surgeries.
Neurosurgical Intensive Care Unit The neurosurgical intensive care unit has 7 physicians and 22 beds, it’s equipped with vital physiological and intensive brain monitoring techniques (including transcranial Doppler and cerebral metabolism). The unit is prepared to treat even the most critical perioperative cases.
Neuroimaging Center In the early 1990s, the neuroimaging center was the first to use magnetic resonance imaging in China. It is now equipped with five MRIscanners (3.0 telsa), four CT scanners, and two digital subtraction angiography (DSA), and magnetic encephalogram units.
Picture Archiving and Communication System Since 2002, the results of all laboratory and imaging studies in the clinic have been available anywhere in hospital through an intranet. It also serves the administration and enables all resources to run more efficiently.
Research Center: Beijing Neurosurgical Institute
Founded in 1960, the research center includes research departments in neuropathology, microanatomy, neurotransmission, neuroendocrinology, neural injury and repair, neural stem cells, neurobiology, and cerebrovascular disease, as well as a state-certified laboratory animal center. Dr. Zhao Yadu, deputy director and internationally renowned neurosurgeon, has devoted his life to clinical and basic research in neurosurgery.
Yearly, domestic and international visitors come to this institution, including world-renowned neurosurgeons such as Drs. Kawase, Al-Mefty, Laws, Rhoton, Ausman, Suzuki, Dolenc, Samii, Perneczky, Bason, Atos, etc. Annually, it hosts national conventions of neurosurgery and continuous training courses in microanatomy, surgical technique, new concepts of neurosurgery, etc. Hundreds of participants from China attended. It successfully organized the 2rd and 11th Congress of Asian-Oceanian Skull Base Society in 1993 and 2012,respectively.
Residency and Fellowship Training
Because of the abundant clinic resources and high-quality training program, this institution attracts the most competent candidates for resident training and fellowship. Yearly, about 20 residents and more than 100 neurosurgeons from China receive their training and fellowship at Beijing Tiantan Hospital. It is open to international visitors for observation.
Because of geographic development limitations in the current location, a new hospital will open in 2017 in the south suburbs of Beijing. The capacity will double. World-class facilities and service will be offered to patients.
Basically, neurosurgery practice started after 1950. After the Korean War, the central government organized the first 1-year training course in neurosurgery in 1955 in Beijing. The trainers were Dr. Zhao Yicheng and former Soviet Union neurosurgeon Dr. Artuinov. After the training course, the trainees returned to their hospitals to develop neurosurgery. Dr. Wang Zhongcheng was one of the trai…