A glance at Chinese neurosurgery

The economy of China in the past three decades has boosted the development of neurosurgery in China. Currently, thousands of active neurosurgeons, all over the mainland of China, practise their clinical and basic research in all the fields of neurosurgery. Great achievements have been made in each specialty of neurosurgery. Although many modalities have been introduced, cerebrovascular disease is still an important field for neurosurgeons. In the past five decades of development, neurosurgery, particularly minimally invasive neurosurgery and surgical treatment of patients with giant intracranial aneurysms (GICA) have progressed in China greatly. Xu et al¹ introduced their experience in surgical management of large and giant intracavernous and paraclinoid aneurysms in this issue. Qi et al² reported on the clinical characteristics and surgical treatment of patients with GICA. Both topics are very attractive and informative for this ongoing hot topic that is a big challenge for neurosurgeons. These authors have published extensive volumes on neurosurgery in China which are worthy of reading. In addition to how to clip aneurysms, they also cover the complications that should be avoided. Ocularmotor palsy is a common complication postoperatively. Yang et al³ reported on nerve recovery.

Stereostactic radiotherapy has been considered a good alternative management for arteriovenous malformations, although there has been a reasonably acceptable failure rate. Liu et al⁴ reported that the 7 cases of failure after radiosurgery demonstrates the importance of long-term follow-up and consideration of whether an operation is necessary.

Endovascular intervention has been practised in China for several decades. The most advanced device has been available for clinics in China. Its cost and benefit has been controversial since its birth. Wang et al⁵ compared conservative therapy alone and conservative plus endovascular therapy for clinical outcomes of elderly patients with symptomatic vertebrobasilar stenosis.

Dr. Tian et al⁶ of the brain trauma section reported on the risk factors for hospital mortality in patients who have undergone surgical treatment for isolated traumatic acute subdural haematoma. His report may help clinicians to determine management criteria and improve survival rates. In addition to brain trauma, peripheral nerve injury is also common and an important area for neurosurgeons, but most of our Chinese neurosurgeons are not familiar with this field. Chen et al⁷ reported on a preliminary positron emission tomography study of brain glucose metabolic changes associated with chronic spontaneous pain due to brachial plexus avulsion.

Glioma is the most common type of malignant brain tumour and the overall prognosis of glioma is still poor. Moreover, the prognosis of patients diagnosed with grade III gliomas varies significantly. Zhu et al⁸ reported on the prognostic factors for such patients.

Computer technology has extended in every field of modern medicine. Virtual reality technique provides a good way for better understanding of anatomic pathology. Yi et al⁹ reported their experience with virtual reality technique in preoperative planning in skull base surgery. It reminds our neurosurgeon never depart from our ever advancing computer technology. Sometimes innovation does not only mean high technology, it means some inspiration from daily work. Hu et al¹⁰ reported their interesting tip of liquid capsule application after resection of a giant meningioma to avoid the postoperative complication. Functional neurosurgery is also a promising part of neurosurgery, including epilepsy, movement disorder and pain management. Zhang et al¹¹ reported on dorsal root entry zone coagulation for treatment of deafferentation pain syndromes.

Although spinal neurosurgery accounts for a small part of clinical work for Chinese neurosurgeons, subdural tumours belong to the neurosurgical specialty. Wang et al¹² reported on combined microneurosurgical and thoracoscopic resection of thoracic spine dumbbell tumours. Additionally, two rare cases are reported, one is moyamoya disease with arteriovenous malformation¹³ and the other is fracture of a cerebral protection device wire in carotid artery stenting.¹⁴

Papers in this issue^1-14 are only a small glance at our Chinese neurosurgeon colleagues. Currently, the Chinese Neurosurgical Society (CNS) has registered nearly 7000 active neurosurgeons as its members all over China. The conventions involve each specification, such as tumours, cerebral vascular diseases (CVD), minimally invasive approaches, functional neurosurgery, trauma, etc. Today's Chinese neurosurgeons actively participate in international events. Some neurosurgeons are invited to be reviewers of international journals, such as Neurosurgery, Surgical Neurology, Neurosurgical Review, Child Nervous System, and Journal of Clinical Neuroscience and so on. Participation in international events helps Chinese neurosurgeons learn about the world and vice versa. Today's achievements of Chinese neurosurgeons may be of international interests not only in clinical practice, but also in basic research.^15,16 Currently, hundreds of Chinese neurosurgeons have experienced overseas practice or training. I believe that more and more papers written by Chinese neurosurgeons will be published in international journals in the near future.