At present, the Department of Neurosurgery of NINGBO MEDICAL CENTER LIHUILI HOSPITAL is the largest, best-equipped neurosurgery department in Ningbo, and the new round of key medical disciplines in Ningbo. Compromising two zones and three wards, the department is served by 32 neurosurgeons including 9 chief physicians, 6 deputy chief physicians, 9 attending physicians and 8 resident physicians, with a reasonable and adequate talent pool. There are subspecialties such as cranial base surgery, cranial tumour, cerebrovascular disease, neurological intensive care, and neurological functional disease, each subspecialty demonstrates proven clinical strength and privileged academic standing in Zhejiang Province, and the DRG rank of associated diseases is among the top in Zhejiang. At present, the main directions and characteristics of the disciplines include:
(I) Broadening the field of application of neuroendoscopy, introducing technologies, and brining technological innovation into practice
Keeping up with the pace of domestic and overseas development, and introducing new ideas, techniques and methods in the past years, the neuroendoscopic techniques have been the preferred treatment protocol for pituitary adenomas and craniopharyngiomas, and are broadening its access to other fields of neurosurgery. At present, neuroendoscopic procedures such as transnasal skull base tumour resection, deep transcranial tumour resection, transcranial microvascular decompression and intracranial aneurysm clamping are regularly performed. The next step will deal with the further broadening of the application of neuroendoscopy, especially for the inaccessible sites by traditional surgical methods, and actively perform the endoscopic-assisted transcranial-superior cerebellar procedure to remove tumours behind the third ventricle, the endoscopic-assisted craniotomy, and the clipping of anterior and posterior circulation aneurysms.
(2) In reliance of the solid foundation of cerebrovascular disease treatment, establishing a whole chain of diagnosis and treatment system
The cerebrovascular disease subspecialty with 30 beds available, 2 chief physicians, 2 deputy chief physicians, 3 attending physicians and 2 resident physicians is believed to be the largest specialized treatment team for cerebrovascular disease in Ningbo, and demonstrate the capacity to treat the whole series of cerebrovascular diseases. Both hospitals have an advanced stroke center and well-equipped green channel for emergency stroke treatment, and regularly perform mechanical thrombectomy for acute ischaemic stroke. In addition to surgical and interventional treatment for aneurysms, cerebral arteriovenous malformations and chronic occlusions, difficult procedures such as endarterectomy for internal carotid artery stenosis, intracranial vascular bypass surgery, and clipping of posterior circulation aneurysm are regularly performed so as to avoid the travel needs for patients to seek non-local medical attention. In addition, efforts were made to specialize in the minimally invasive treatment of cerebral haemorrhage, and both zones can independently perform stereotactic intracranial haematoma evacuation and neuroendoscopic intracranial haematoma evacuation, so that the sequelae of patients would significantly ease. As a participant in the National Key Research and Development Program project "Establishment of a standardized system for minimally invasive treatment of cerebral haemorrhage based on imaging histology and evaluation of application" (chaired by Prof. Chen Gao at the Second Affiliated Hospital Zhejiang University School of Medicine), the number of cases included in the study is second only to that of the Second Affiliated Hospital Zhejiang University School of Medicine.
(3) Enabling the specialization in neurological intensive care, developing a neurological intensive care center
The interdependence of neurocritical care medicine and neurosurgery specialty underlines the further development of neurosurgery to higher and more difficult fields. With the only independent neuro intensive care unit (NICU) set in place, efforts were made to introduce the concept of neuro intensive care, train professional neuro intensive care physicians, and routinized intracranial pressure monitoring, subcritical techniques, early rehabilitation as the monitoring and treatment protocols, which in turn backs up the combined therapy of perioperative treatment and severe cranial injury using high-grade, precision and advanced surgical operations. At present, NICU makes 8 beds available and is expected to be further expanded to a neuro intensive care center with 16-20 beds in the coming 2-3 years, equipped with professional medical and nursing teams, advanced monitoring technologies such as cerebral blood flow monitoring, cerebral oxygen monitoring and neuroendocrine function monitoring, among the first tier of Eastern Zhejiang and trusted by fellow neurosurgery departments.
(4) Boosting the fusion of multiple disciplines, exploring the new modes of specialized treatment
From the onset of specialization, drastic advances have been made in respect of the diagnosis and treatment of all neurosurgery subspecialties. As the disease research proceeds on, the limitations of a single discipline are further exposed. To address this concern and provide the best treatment options for patients, the Multi-disciplinary Team (MDT) has been routinized with vast deliverables in clinical practice. Efforts will be made to boost the fusion of multiple disciplines. With regard to the three most common diseases in MDT, skull base diseases, sellar regional tumors and glioma, relevant departments are instructed to set up the specialized disease center. The treatment panel consisting of some members of all departments is formed by digital means within the centralized framework. A single discussion transmits to the whole process of communication. All problems in connection with patient consultation, diagnosis, surgery, post-operative management and rehabilitation are resolved in one stop. The one-entity diagnosis-treatment mechanism is orchestrated.
(5) Introducing neuromodulation technology, enriching the content of functional neurosurgery
At present, Ningbo’s neurosurgery still has some voids in certain functional neurosurgical diseases such as movement disorders, chronic intractable pain, intractable epilepsy, Parkinson's and peripheral neurovascular diseases, and can hardly suit the needs of patients. Our neurosurgery department has trained 5 physicians skilled in stereotactic intracranial haematoma evacuation techniques in both hospital zones, and the number of stereotactic surgeries in the past two years has exceeded 100 cases each year, standing in the first tier of Zhejiang Province. The accuracy of stereotactic surgery is now up to 1mm, and any of the skull zones is accessible through different surgical approaches, with technical and team condition established for the application of neuromodulation in the treatment of functional neurological diseases. In addition to the routinized operation of trigeminal neuralgia and facial spasm, the introduction of neuromodulation-related technology enriches the content of functional neurosurgery, treats the above-mentioned diseases and improves the life quality levels of these patients.