In the context of the development of human civilization, a century but a blip in time, but in the last hundred years in China there have been astounding developments in the field of neurosurgery.
Neurosurgery of equally high standard throughout China has been late in arriving, but a huge neurosurgical caseload has allowed Chinese neurosurgeons to quickly catch up with their counterparts in the West.
As Wang Zhongcheng, the only neurosurgeon to be made an academician of the Chinese Academy of Engineering, and the director of the Beijing Neurosurgical Institute, told China Daily, any type of difficult clinical neurosurgical operation can be now done in China.
Known as one of the founders of neurosurgery in China, Wang, 78, has established an enviable record in the field of neurosurgery worldwide.
He has done 520 operations on brain stem tumours, with a mortality rate of less than 1 per cent. He has operated on 207 skull base tumours, with a mortality rate of 2.4 per cent. More than 100 operations on malignant tumours located in the cerebral ganglion - the mass of grey matter in the central nervous system forming the nerve-nucleus - have also been performed by Wang and his students.
Several sub-fields of neurosurgery in China stand high in international medical circles.
The treatment of brainstem tumours was once a no-go zone in the neurosurgical field. Since the brainstem, roughly the size of the human thumb, functions like the switchboard for the brain, for many years, neurosurgeons around the world have been hesitant about touching it.
Starting in the early 1980s, Wang and his colleagues have been treating brainstem tumours and they have worked out and reported a whole set of valuable procedures.
"The more than 700 brainstem tumour operations in Tiantan Hospital rank it first in the world," said Wang, who in 2001 became the first Chinese to win the Supreme Neurosurgery Award, granted by the World Federation of Neurosurgical Societies, for his pioneering work and great contributions in the field.
Chinese neurosurgery got its preliminary kickstart after the founding of the People's Republic of China in 1949, and has advanced more rapidly since the country's opening up movement began in the 1970s, with the aid of highly developed neuroradiological equipment and other techniques brought into the country as a result of the increased communication between Chinese neurosurgeons and those in the rest of the world, Wang said.
The incidence of rare cases in China is significant, as the country has the largest population of any country in the world. According to recent epidemiological data, the incidence of brain tumours in China recently increased to about 7 in 100,000.
While helping relieve patients' pains and illnesses, Wang and his colleagues have developed unrivaled competency in clinical treatment of neurological disease.
"Clinical neurosurgical operations in the neurosurgical wards in major hospitals in China's biggest cities rank with the best in the world," Wang said with confidence. "Our rich clinical experience enables us to do operations which might seem impossible in other countries."
Last February, a patient surnamed Zhou with a huge brain tumour arrived at the Beijing Tiantan Hospital. Brought in in a coma, the patient had been transferred from a hospital in the United States, where he had already undergone surgery, during which part of the tumour had been removed, but the patient had lost 4,000 millimetres of blood.
Neurosurgeons in Beijing Tiantan Hospital chose to remove the entire tumour in one operation, which required extremely sophisticated and precise clinical skills. The operation was a success, and Zhou has recovered his eyesight and begun to walk again.
"Their rich clinical experience has made it possible for Chinese neurosurgeons to choose the most appropriate operating technique," said Wang.
Major neurosurgery departments, such as the ones of Tiantan Hospital in Beijing and Huashan Hospital in Shanghai, are world leaders in the development of microsurgery, with thousands of such operations having been conducted over the past decades.
Microsurgery is an operating technique involving the use of the microscope, which gives surgeons much easier and more accurate access to the targeted locations while performing surgery.
"The advancement in microsurgical skills has helped improve neurosurgical practices as a whole, as injury to the brain during operations is kept at a minimum and tumours can be removed in their entirety," said Wang.
There are few forbidden areas in brain surgery in the 21st century, the "century of the brain," Wang said.
Chinese neurosurgeons have developed and applied several special high-tech diagnostic and therapeutic methods, such as neuronavigation and the use of artificial intelligence.
They have adopted "minimally-invasive" techniques, to minimize the suffering of patients undergoing operations. This is still one of the main concerns of most medical experts in the world today, both in China and the world at large.
In China, there are three established neurosurgical centres, Beijing Tiantan Hospital, Tianjin General Hospital, and Shanghai Huashan Hospital. The three have been the dominant hospitals in the field for many years.
The Guangdong 999 Neurological Surgery Hospital, a new addition to the neurosurgery field, was opened on March 9, 1996, and is a new and rising star in the field.
The hospital has developed its own specialties in psychosis, epilepsy, malignant pain, and heroin and alcohol addiction treatment. In those areas, it is rising to become one of the leading centres in China and the world.
New frontiers
Wang said that Chinese neuro-surgeons have been keeping abreast of international advances in the field.
One new frontier in neurosurgery is neural stem cell research, which is being carried out in Beijing, Shanghai, and other cities. Neuro stem cells are cultured in the laboratory and then planted in the injured part of the brain to develop into new neural cells.
"Now we are studying how to integrate the newly planted stem cells with the original neural cells," said Wang.
Another frontier in the science is genetic research into brain tumours that begin from glial cells, which provide support functions for neurons. Glial cell brain tumours accounts for about 40 per cent of all brain tumours. Patient relapse are common.
By looking into the genetic origins of this type of tumour, researchers hope to discover better diagnostic and therapeutic methods.
Despite the advances Chinese neurosurgeons have made in clinical practice, Wang admits that China's progress in basic neurosurgical research is lagging behind that in the United States and Europe by at least five to 10 years.
He attributes the slow progress to the lack of funding.
According to recent data, the foundation backing the neurological and neurosurgical departments of the Massachusetts General Hospital in Boston provides US$55 million annually for scientific research, which is approximately 100 times the annual funding for the Beijing Neurosurgical Institute.
"Without sufficient financial support, it is understandable why there has been little creative work in the field of basic research in China," said Wang.
Also, there are a large number of patients waiting for surgery, and the doctors have to spend more time meeting patients' needs, thus leaving themselves little time for basic research.
"Postoperative follow-up of large numbers of patients can be hard, making it difficult to translate clinical experience into clinical research," according to Charles Y. Liu, from Los Angeles, California.
Wang believes that the major challenge for neurosurgical science in China is working out a practicable way to combine clinical practice with research.
Tiantan Hospital now requires all neurosurgical doctors to go to the research institute to do experiments when they are encountering difficulties in their clinical practices.
Another area that Wang and his colleagues must come to grips with is training more young neurosurgeons.
Neurosurgery is a very special field among many branches of clinical medicine. It is filled with challenges and excitement. To become a neurosurgeon is a very demanding challenge. Usually, much special and strict training is required for a medical school graduate to become a neurosurgeon.
According to Chinese Neurosurgical Society statistical data, the number of qualified neurosurgeons practising in China in 2000 was about 4,000. The ratio of neurosurgeons to population in China is about half that of the United States. Especially, in some under-developed areas where the ratio is much lower.
The inadequate number of neurosurgeons, in a way, has contributed to the inequality and backwardness of neurosurgical care in much of China outside its major cities.
This is what worries Wang most. Recently, he wrote a letter to the Beijing municipal government, advocating setting up a neurosurgery college to train new neurosurgeons.
At present, medical graduates who want to become neuro-surgeons must complete a comprehensive training programme of about seven or eight years. "It is necessary to accelerate this process and it is also feasible," said Wang.
China has a huge number of patients waiting for neurosurgery and it is possible for the trainees to complete the 900 operations required by international standards to become a qualified neurosurgeon in a much shorter time, he added.
A new blueprint for a neurosurgery training centre has been examined and approved by the Ministry of Health, which is to be established at the Tiantan Hospital soon. Hopefully, it will become a cradle for Chinese future senior neurosurgeons.
(China Daily 04/13/2004 page1)
(Liu Weifeng)
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