Neurosurgery

STAFF

• Dr. Wai Man LUI
  Consultant and Division Chief
  MBBS, FRCS(Edin), FCSHK, FHKAM(Surg)
  email: mattwmlui@netvigator.com
  
  
• Dr. Kwan-Ngai HUNG
  Consultant
  MBBS, FRCS(Edin), FCSHK, FHKAM(Surg)
  email: hungkn@ha.org.hk
  
  
• Dr. Wilson Wai-Shing HO
  Senior Medical Officer
  MBBS(HK), FCSHK, FRCS(Edin) FHKAM(Surg), LLB(Lond), EMBA(CUHK)
  email: wilsonho2000@yahoo.com
  
  
• Dr. Gilberto Ka Kit LEUNG
  Assistant Professor
  MBBS(London), BSc(London), FRCS(Edin), FCSHK, FHKAM(Surg), M.S.
  email: gilberto@hku.hk
  
  
• Dr. Jenny Kan Suen PU
  Associate Consultant
  BSc. Hon(Canada), MBBS, FCSHK, FHKAM(Surg),
  FRCSEd(Surgical Neurology)
  email: ksjpu@hku.hk
  
  
• Dr. Yat Hang TSE
  Associate Consultant
  MBChB, FRCS(Ed)(SN), FHKAM(Surg)
  email: philipyhtse@yahoo.com
  

Clinical Services

The Division of Neurosurgery is committed to providing the highest level of care to patients with neurosurgical conditions. In addition to offering a comprehensive neurosurgical service to in-patients at Queen Mary Hospital and at a general neurosurgical clinic, the Division also operates other subspecialty neurosurgical clinics, including the Paediatric Neurosurgical Clinic, the Neurovascular Clinic, the Radiosurgery Clinic and the Joint Brain Tumour Clinic at Queen Mary Hospital. A Neuro-rehabilitation Clinic takes place at the MacLehose Medical Rehabilitation Centre.

Common pathologies presented to the Division include brain tumours, cerebral aneurysms, arteriovenous malformations as well as pituitary and spinal tumours. In the emergency setting, the most common pathologies encountered are severe head injuries and cerebrovascular diseases.

Brain Tumour

• The majority of brain tumours treated at our division are brain metastasis, malignant glioma and meningioma. The division takes a leading role in adjuvant chemotherapeutic therapy for malignant glioma and we are developing the use of molecular markers (e.g., MGMT methylation status, chromosomal deletion) in the prediction of treatment response.
• Two ongoing clinical trials on adjuvant chemotherapy for patients with glioblastoma multiforme (GBM).
• We work closely with the Division of Head and Neck Surgery, and the Division of Plastic and Reconstruction Surgery in treating skull base tumour and we have acquired extensive experience in craniofacial resection for anterior skull base lesions such as olfactory neuroblastoma and recurrent head and neck cancer.

A large anterior skull base tumour treated with craniofacial resection

• Intra-operative monitoring procedures, such as somato-sensory evoked potential (SSEP), motor evoked potential (MEP) and electrocorticography (ECoG) are used regularly as surgical adjuncts to maximize patient safety.
• 5-aminolevulinic acid (Gliolan) induced porphyrin fluorescence guided resection of malignant glioma: To facilitate the gross total removal of malignant gliomas, we employ the technique of immunofluorescence-labelling of tumour cells (Gliolan).
  
• Advanced neuroimaging, such as functional MRI and DTI, to facilitate more accurate pre-operative diagnosis and assessment.
• Stereotactic radiosurgery is an important part of our armamentarium in the treatment of brain tumours. Our division plays an active role in X-knife treatment procedure.

Pituitary Surgery

• The majority of pituitary tumours are treated surgically with the endonasal endoscopic approach. The latter allows close-up visualization and good illumination, minimizes tissue injury and facilitates complete tumour removal.
• In addition to the development of endoscopic transsphenoidal surgery in the last decade, our division has also pioneered the simultaneous combined transcranial-transsphenoidal approach to giant pituitary adenoma. This approach has enabled us to achieve complete resection of large pituitary tumours safely in a single setting which previously would require two separate procedures.

The intra-operative setting of the combined transcranial-transsphenoidal approach

Neurovascular Diseases

• Endovascular intervention has revolutionarized the treatment of neurovascular diseases in recent years. These include embolization of cerebral aneurysms, arteriovenous malformation, dural arteriovenous fistula, as well as preoperative embolization of brain tumors.
• Ischemic conditions resulting from intra or extral-cranial arterial stenosis are now amenable to angioplasty with / without stenting.
• Our centre has pioneered the extracranial-intracranial (EC-IC) bypass procedure in Hong Kong which is a major break-through for cerebral revascularization in the treatment of aneurysm not amendable to endovascular embolization or conventional clipping (e.g., giant aneurysms and radiation-induced carotid artery aneurysms.)

Extracranial-Intracranial (EC-IC) Bypass

Spinal Surgery

• Neurosurgeons are playing an increasing role in the treatment of spinal conditions in Hong Kong. In addition to spinal tumours and spinal dysrhapism, we have expanded our service to spinal degenerative diseases.
• We are the first in Hong Kong to adopt the antero-lateral approach to cervical tumors which allows complete resection of, say, a large Schwannoma while preserving spinal mechanical stability and therefore obviates the need for permanent fixation.

A left cervical spine tumour

Left anterolateral cervical approach

Functional Neurosurgery

• Movement disorders (e.g., Parkinson's disease) refractory to medical therapy are treated at our unit with functional neurosurgery techniques, including subthalamic nucleus deep brain stimulation (DBS).
• We regularly perform various types of surgical procedures for refractory epilepsy including hippocampectomy, corpus callosotomy and functional hemispherectomy, as well as for pain syndrome, such as trigeminal neuralgia.

Case Management

• Our unit is the first in Hong Kong to have a dedicated nursing staff (Case Manager) to coordinate clinical services for patients undergoing elective surgery. Eight other senior nurses have already completed in-service rotational training to prepare them for advanced practice in neurosurgery or other surgical disciplines.

Research

(I) Neuro-oncology

• Clinical trial on the effect of Bevacizumab in combination with Irinotecan for treatment of malignant glioma
• Two ongoing clinical trials on adjuvant chemotherapy with Cilengitide, Bevacizumab and Temozolomide for newly diagnosed glioblastoma multiforme after surgical resection
• Chemotherapy-resistance in malignant glioma – role of microRNA
• Genetic markers for the prediction of response to chemotherapeutic agents in primary and secondary brain tumours. (e.g. MGMT methylation status and 1p19q chromosomal deletion)
• Quality-of-life studies
• Peri-operative somatostatin analogues for acromegaly
• Molecular genetics of malignant brain tumor in Hong Kong
• Hong Kong brain tumor registry

(II) Neurotrauma

• Neuropathology of surgery-induced brain injury and its modulation
• Application of self-assembling peptide nanofiber scaffold (SAPNS) on the traumatic brain injury
• Diffuse axonal injury (DAI) animal model studied with the Diffusion Tensor Imaging (DTI) Magnetic Resonance (MR) technique
• Metabolic changes in brain trauma studied with microdialysis technique and Magnetic Resonance Spectroscopy (MRS)
• Head injury and Trauma System in Hong Kong

(III) Neurovascular Surgery

• Cerebral revascularization (EC-IC bypass) and techniques of microanastomosis
• Cerebroprotective therapies for reperfusion injury after cerebral ischaemia

(IV) Others

• Intra-operative monitoring and electrophysiological mapping during cranial and spinal operative procedures
• Stem-cell therapy for neuroregeneration
• Cadaveric dissection laboratories

Collaborations

• Our division plays an active role in many multi-disciplinary clinical meetings held regularly in Queen Mary Hospital including the Brain Tumour Meeting, Neuroradiology Meeting, Epilepsy Surgery Meeting, Radiosurgery Meeting and Neurovascular Meeting. We also offers our service, when consulted upon, to other affiliated hospitals in Hong Kong.
• With the Department of Anatomy in conducting cadaveric dissection workshop.
• With the Hong Kong Neurosurgical Society in organizing seminars and live-demonstration of advanced neurosurgical procedures given by invited world-renown experts.
• With the Division of Endocrinology and Metabolism, Department of Medicine, in the study on the use of peri-operative somatostatin analogue in the treatment of acromegaly.
• With Department of Anaesthesiology in the study on platelet function assays in neurosurgical patients taking anti-platelet agents.
• With the Medical Engineering Programme, Faculty of Engineering, in developing advanced imaging and neurovascular models for clinical and basic research.