To help the world, to save lives and to help the injured is his constant professional pursuit; to strive for excellence, to return to the spring is his continuous development of the way forward. With more than twenty years of clinical experience, he has always strictly demanded himself with the faith of doctors, and kept moving forward in learning and practice. He is Han Hongyan, Daya Hongda, Shuoyan famous Confucian, is his true portrayal of people as doctors.
He is the director of functional and minimally invasive neurosurgery at the Aviation General Hospital, a member of the Chinese Young and Middle-aged Neurosurgery Exchange Association, and a young member of the neurosurgery committee of the Chinese Medical Association Beijing Branch. He has been engaged in clinical work of neurosurgery for 20 years, specializing in surgical treatment of various types of drug-refractory epilepsy, new combined vascular bypass surgery for smog, minimally invasive surgery to remove intracranial tumors, intravertebral tumors, cerebrovascular malformations, manifest microvascular decompression for facial muscle spasm, trigeminal neuralgia, and hydrocephalus and other neurological diseases. He has attended many international academic conferences and published more than twenty academic papers, including five SCI (Science Citation Index) papers.
One afternoon in early summer in Beijing, we had an interview with Director Han Hongyan, and when we arrived at his office at 4:00 p.m., his door was closed. When we asked the nurse who passed by, she said that Director Han was still in surgery. After we waited for about half an hour, Director Han returned to his office, greeted us, and asked us to wait outside his office because there were several patients waiting to consult him on various issues. We waited until about 5:30 to see off the last patient before greeting us and walking into his office, where we started our conversation with his “busy” schedule.
Note: Hello, Director Han! It seems you are really busy, thank you very much for taking time out of your busy schedule to accept our interview, according to our understanding, you are engaged in clinical work in neurosurgery for twenty years, may I ask you think what is your greatest achievement in medical art in the past twenty years?
Han: I can’t say that I have made any great achievements, but I feel that the greatest psychological comfort is that I have successfully treated many critically ill patients, patients with complex intracranial tumors and patients with intractable epilepsy, and the most important point is that in recent years, I have mastered the best international surgical method for treating smog. Some patients who cannot be treated in other hospitals have found us through various channels.
Remember: Many patients come to us because you are unique in the surgical treatment of smog. What are the characteristics of smog? What are your innovative experiences in treating smog?
Han: Smog is a cerebrovascular disease characterized by progressive narrowing and occlusion of the superior segment of the internal carotid artery (ICA) and its major branches within the circle of Willis. These vascular occlusions lead to the formation of a network of collateral vessels at the base of the brain. Therefore, Japanese scholars Suzuki and Takaku named this cerebrovascular lesion “smoker’s disease” in 1969. It is now known that the main pathological feature of smog disease is the progressive stenosis of the end of the internal carotid artery and the formation of smog vessels through the dilated arteries, which function as collateral vessels to compensate for the blood supply of the internal carotid artery.
Smoke disease often leads to cerebral ischemia in the area supplied by the internal carotid artery, especially in the frontal lobe. Most patients will exhibit frontal lobe signs and symptoms such as dysarthria, aphasia, or hemiparesis. Other atypical symptoms such as syncope, lower extremity bradykinesia, visual symptoms, or involuntary movements may also be present, and pediatric cases are more likely to present with these symptoms. Some pediatric cases develop mental retardation due to frontal lobe cerebral ischemia or infarction. Adult patients can also suffer from memory loss and even cerebral infarction and cerebral hemorrhage if left untreated. Therefore, if not properly treated, smog disease has a high rate of disability and death, which seriously affects the life and quality of life of patients.
The current surgical methods for the treatment of smog are: direct bypass (vascular bypass) surgery, indirect bypass (patching) surgery, and combined bypass surgery. Vascular bypass surgery includes anastomosis of the superficial temporal artery to the middle cerebral artery (STA-MCA); in some patients with severe ischemia in the anterior cerebral artery supply area, STA can also be anastomosed to a branch of the anterior cerebral artery (STA-ACA). The advantage of vascular bypass surgery is that it can improve cerebral hemodynamics immediately after surgery and reduce the incidence of ischemic stroke, but it is difficult to perform and has a limited scope to improve the blood supply to the brain. There are several different approaches to previous vascular connectivity procedures: cerebral-dural apposition (EDS), cerebral-temporal muscle apposition (EMS), cerebral-dural-temporal muscle-artery apposition (EDMAS), and cranial borehole surgery. The superficial temporal artery, dura mater, temporalis muscle, and soft membrane tissues have been used as tipped donor tissues in these surgical approaches. The patching procedure, which induces neovascularization between the brain surface and the vascular donor tissue, is simple and has been widely used. However, patching has many drawbacks: first, it takes 3-4 months after surgery for bypass vessels to form, and there is still a risk of stroke during this 3-4 month period. Second, studies have found that while neovascularization occurs in almost all pediatric cases, approximately 40-50% of adult patients are ineffective after patching. Third, the extent of neovascularization after revascularization is closely related to the surgical design, and studies have shown that “small craniotomy” is an independent factor contributing to the poor intellectual prognosis in pediatric cases, possibly due to the lack of blood supply to the frontal lobe brain tissue after surgery.
In 2011, I went to Hokkaido University Hospital in Japan as a visiting scholar to study new techniques for the diagnosis and treatment of smog, and successfully introduced a new combined vascular bypass surgery: vascular bypass + cerebral-dural-temporalis-arterio-cranial periosteal patching into China. The innovations of this new combined vascular bypass surgery are: 1) STA-MCA vascular bypass can immediately improve the blood supply to some regions of brain tissue; 2) brain-dural-temporal muscle-artery-cranial periosteum patching can form neovascularization in a larger area, further improving the surgical effect; 3) using frontal cranial periosteum as the donor tissue of neovascularization can form neovascularization in the medial frontal lobe It can improve the cerebral ischemia in the medial frontal lobe, which has an important role in restoring the intelligence and emotion of patients, especially children, to a normal state. In the past six months, we have performed surgical treatment for nearly 50 patients with smog using this method, and all of them were successful. The patients’ symptoms improved rapidly after surgery, and the blood supply to the brain improved significantly, which is sufficient to show that vascular bypass + cerebral-dural-temporal muscle-arterial-cranial periosteal patching is a safe and effective method to treat smog. After more than 10 years of research in Japan, the annual chances of cerebrovascular accidents in children and adults were found to be 0% and 0.4%, respectively, after treatment with this method. The efficiency is much higher than other surgical methods, and the complication rate is relatively low. Thus, vascular bypass + cerebral-dural-temporal muscle-artery-cranial periosteal patching is the best choice for treating smog disease.
Remember: It is known that epilepsy has become the second most common disease after headache in China, and surgery for drug-refractory epilepsy is one of your main research directions.
Han: “Drug-refractory epilepsy” generally refers to epilepsy in which seizures cannot be satisfactorily controlled despite treatment with three or more antiepileptic drugs alone or in combination. In the past nine years, we have treated a large number of patients with refractory epilepsy, and the cure rate has reached the international top level. Most notably, I have accumulated more extensive experience in the surgical treatment of functional zone epilepsy. Functional area epilepsy is a condition in which the epileptogenic foci of seizures are found to involve important functional areas of the brain as assessed by various evaluation tools. The previous view was that functional area epilepsy was not suitable for treatment by resective surgery, because if the functional area epileptogenic foci were removed, then the functional areas would be similarly removed and the patient would likely have postoperative sequelae such as hemiparesis and aphasia. However, after years of clinical practice, we found that as long as the preoperative evaluation can accurately locate the epileptogenic foci, then the epileptogenic foci located in the functional area can be resected. We have treated nearly 20 cases of functional epilepsy patients with epileptogenic foci, and we have not only obtained satisfactory results in terms of epilepsy control, but also no sequelae such as hemiplegia and aphasia.
Note: What are your future research priorities in the medical field? Why?
Han: I think the focus of my future research will be on smog. I have recently established the Smog Research Unit at the Beijing Institute of Translational Medicine of the Chinese Academy of Sciences to conduct more in-depth research on smog-related topics, including the etiology and epidemiology of smog, as well as the effects of combined vascular bypass on cerebral hemodynamics, long-term effects, and complications of smog treatment. The reasons for making smog disease a priority research topic in the future are: first, with the popularity of non-invasive examinations such as magnetic resonance angiography, more and more patients can be diagnosed with smog disease; second, at present, most doctors in China do not know much about smog disease and know little about smog disease treatment, so they often cannot give proper treatment advice to smog patients; third, even some medical units that can surgically Third, even if some medical units can treat smog, most of the surgical methods they use are traditional methods, which are easy to operate and popular, but it is difficult to obtain satisfactory results, so smog patients are under the shadow of the disease for a long time, which seriously affects the quality of life of patients and their families. In the near future, we hope to explore measures to prevent smog and methods to cure smog, and promote these results in China to benefit the majority of smog patients.
Remember: It is said that you have performed many surgeries that other specialists are afraid to do, which means that you have taken more risks. Or do you do it out of compassion for the patient? Have you ever considered the consequences in case the operation fails? Can you give me an example of an operation that you remember as being more dangerous but successful?
Han: The success rate of a surgery is crucial to a doctor’s reputation, but as a responsible doctor, the first consideration should not be your reputation but the life of the patient. There is a certain risk in any surgery, and we can’t not do it because of the risk. In some patients, although the surgery is difficult and extremely risky, they will lose their chance of survival if they do not have surgery. In this case, we communicate with the patient and his family repeatedly, explaining the pros and cons of the surgery, and after obtaining the full understanding of the patient and his family, we perform the surgery for the patient. Therefore, no matter what the situation is, I treat every patient seriously! At the same time, I am very confident in my medical skills, and I believe that as long as we do each step of the operation carefully and meticulously, the chances of success are high. Moreover, because we have done our best, in case the result is not satisfactory, the patient’s family will usually understand, after all, no doctor can cure all patients. Our entire procedure is videotaped and can stand up to the accreditation of international medical authorities. One of my more impressive surgeries was an 80-year-old female patient with a huge intracranial tumor who went to many major hospitals in Beijing for medical treatment. After this patient found me, we decided to operate on the old man in view of the fact that the intracranial tumor had seriously threatened his life. After meticulous preoperative preparation, the huge intracranial tumor was removed by craniotomy under general anesthesia, and because of the meticulous operation, there was very little bleeding and no blood transfusion. After the operation, the patient recovered smoothly without any complications. When the old woman was discharged from the hospital, her partner and children were so happy that you can imagine, and I myself felt a sense of pride as a doctor. There is another case worth mentioning. She is a 77-year-old woman who went to a hospital in Shanghai Fudan University in July 2012 because of an intracranial tumor located near the brain stem. At this time, her daughter found me and consulted me to see if there was any hope. I looked at the film and thought there was still a ray of hope for the operation, so after careful consideration, I decided to give the old man a try. After a difficult 6-hour procedure, the surgery was successful! The patient is still alive and healthy to this day.
Many patients now know that the functional and minimally invasive neurosurgery department of Beijing Aviation General Hospital is able to locate intracranial lesions very precisely and use minimally invasive surgery to remove the lesions, which minimizes surgical trauma and can greatly shorten the patient’s recovery time after surgery, so many patients come to us.
Note: On a side note, when we were waiting for you in the aisle, we saw the full text of the Disciple’s Rule posted on the bulletin board and the learning experiences written by some of the medical and nursing staff.
Han: “Disciple’s Rule” is our excellent traditional culture, and the hospital has organized the study for cadres above the middle level before. Therefore, I think it is necessary to organize all the medical and nursing staff in the department to learn the “Disciple’s Rules”. Within a month, we took advantage of the medical staff’s morning shift time to carefully study the full text of “Disciple’s Rules”. Through this study, all the staff in the department had a profound experience and wrote out their feelings after reading it, and they consciously used the ideas of the Disciple’s Rule to guide their work: Disciple’s Rule, the sage’s instructions, first filial piety and fraternal duty, second respectfulness and trust
The disciple’s teaching is: First filial piety and fraternal duty, second respect and faith, second respect and faith. As a result, the doctor-patient relationship has become more harmonious. Many patients have sent us banners or letters of appreciation after they were discharged from the hospital, and we are very happy about that!
Post-operative of a patient with smoker’s disease
80-year-old meningioma patient 1 month after surgery