Masterclass 2 - New Service Model in Neuroscience

We are glad that our Hybrid theatre with intraoperative CT was installed in 2022, this made a tremendous move to our comprehensive neurovascular service in HKEC. Nevertheless, we are not the only users, other stakeholders include anesthetists particularly pain team, vascular surgeons, orthopedic surgeons, and interventional radiologists.
This is one of the first state of the art technology in HA hospitals, and we can now provide 24/7 real time imaging and operation in one location, particularly useful in trauma setting which requires multidisciplinary input and multimodalities of treatment including opening surgery and endovascular treatment. Stroke service is another highlight and we are proud to provide 24/7 service for acute ischemic stroke as well as hemorrhagic stroke. Moreover, combination of endovascular and open surgical treatment is particularly helpful to some patients requiring neurovascular service, such as external ventricular drain insertion and embolization of aneurysm can now be catered without patient’s transfer. Spine intervention together with neuro-navigation is another breakthrough which can shorten the learning curve and reduce the radiation hazard for our new generation. CT scan at the same site right after treatment can illustrate the results of surgery without any delay.
For Hybrid Neurovascular service, we will share some cases to illustrate our collaborative effort in both elective and emergency surgery workflow. For example, we will demonstrate a complex vascular case that utilize our 3D printing technology for pre op planning and simulation; We will also show our case series of chronic subdural hematoma management with combined burr holes drainage and MMA embolization in order to provide one-stop treatment strategy to reduce recurrence in high-risk patients. 
In conclusion, streamlined treatment strategy and workflow can provide the best outcome for our patients, and we hope to increase our capacity so that more patients can be benefit in the near future.

Skull base disease is often regarded as one of the most challenging pathologies, due to the close proximity of neurovascular structures. In the past, ENT surgeons and neurosurgeons often see patients separately and make independent clinical decisions. In order to communicate more effectively with the patients and across different teams, KCC has started its multidisciplinary skull base service model since 2020. We focus at three areas: training, teamwork and technology. The team works closely together during patient encounter, surgical planning, management ideas generation and even surgical innovation. Through collaboration, the team is able to provide the best management option to the patients in Hong Kong, and together we develop the new heights in the field of multidisciplinary skull base surgery and minimal invasive surgery at a regional and international level.

Falls are common in elderly and being one of the leading causes of head injury in older adults. The role of geriatric assessment to optimize care for these elderly patients admitted with head injury is gaining increasing attention in recent years as these patients commonly suffer from one or more geriatric syndromes such as fall, delirium, incontinence, etc. prior and during their hospital stay. 


Aspired by the success of the Ortho-geriatric collaborative care model for geriatric patients with hip fracture, neurosurgeons and geriatricians at Prince of Wales Hospital (PWH) and Shatin Hospital (SH) collaborated to pilot a pioneer Neurosurgery-Geriatric Co-care Programme since November 2018. 


Target patients of the Neurosurgery-Geriatric Co-care Programme are adults aged 70 and older who are admitted under Neurosurgery for fall-related head injury and their new patient journey is highlighted as below:
- In acute neurosurgical ward, patients will be co-cared with Geriatric Liaison Team three times per week for peri-operative optimization of medical condition and to triage for rehabilitation needs. 
- In convalescent surgical ward, Geriatric Liaison Team will conduct regular ward rounds on weekdays to address on-going active medical issues, maximize functional recovery, implement early discharge planning and arrange post-discharge support as appropriate. 


Evaluation of the Neurosurgery-Geriatric Co-care Programme revealed encouraging results which we would like to share with you in the presentation. 

 MRgFUS is an advanced incisionless therapeutic technology mainly for treating movement disorders (e.g. Essential tremor, Parkinson's disease, dystonia) and even for psychiatric and oncological conditions. It is becoming a popular alternative to medication and surgical intervention for many medication-refractory conditions. The Hospital Authority is the first in Hong Kong to introduce this highly specialized service which will be available in the fourth quarter of 2024. 
The COC of Neurosurgery has devised a tailored service model to ensure continuity of care and equity of patients' access to this treatment while matching the unique manpower distribution in Hong Kong.
With the completion of the new operating theatre extension block in Tuen Mun Hospital, the novel MRI guided Focused Ultrasound machine (Exablate Neuro 4000, Insightec) will be installed within the intraoperative MRI suite. Being one of the state of the art treatment modalities available in New Territory West Cluster (NTWC) neuroscience center, it will benefit patients with movement disorders who are refractory to medical treatment and unsuitable for invasive intervention.

Neuromodulation such as stereotactic lesioning surgery and deep brain stimulation (DBS) has been used for decades for management of advanced movement disorders. Unfortunately, these surgical treatments are associated with complications such as intracerebral haemorrhage, infections, damage to adjacent structures and are less acceptable by the elderly patients. Recently, magnetic resonance imaging (MRI) - guided focused ultrasound (MRgFUS) surgery has been introduced as a novel surgical treatment for advanced movement disorders, namely essential tremor and tremor dominant Parkinson's disease.
In this presentation, I am going to discuss the principle of MRgFUS in the management of movement disorders. I will also review the literature on MRgFUS in movement disorders and compare its use with DBS. Besides, I will go through patient selection criteria and post-operative treatment.