The Hospital Authority has introduced the MRI guided Focused Ultrasound Machine (Exablate Neuro, Insightec) to Hong Kong in 2024, which is the first and only machine in Hong Kong to perform incisioness thalamotomy for treating Essestial Tremor. 
5 patients have been treated so far and all of them have significant improvement in Clinical Rating Scale in Tremor (CRST).
An overview of the service including referral pathway, patient journey, surgical aspects and outlook of the technique will be presented.

Introduction
Stereo-Electroencephalography (SEEG) has become a cornerstone in the presurgical evaluation of drug-resistant epilepsy cases, offering precise intracranial monitoring with minimal invasiveness compared to traditional invasive subdural and depth electrodes implantation in previous era.  This state-of-art is nicely matching with our advancements in neuro-navigation system, and the evolution is enhanced with the introduction of neurosurgical robotic system resulting in accuracy and efficiency refinement of SEEG electrode implantation and the extended therapeutic intervention.  This presentation reviews the evolution of SEEG technology in epilepsy surgery at Queen Elizabeth Hospital, comparing outcomes between frameless and robotic assisted systems across 12 cases.


Method
We retrospectively analyzed 12 consecutive SEEG operations performed at our department, comprising 7 cases utilizing frameless neuro-navigation system and 5 cases employing neurosurgical robotic system.  Key metrics evaluated include:
1.    Operational efficiency
2.    Accuracy
3.    Clinical outcomes
4.    Technical challenges and solutions


Result
12 SEEG operations were performed from November 2020 to February 2025 in 11 patients.  They consisted of 7 male and 4 female patients with median age of 36 (24-49).  Preliminary data suggest that SEEG had superior advantages compared with traditional invasive EEG electrodes implantation.  Robotic-assisted SEEG implantation offer superior entry and target precision and reduced procedural time compared to frameless techniques.  Insignificant complication rate were achieved with comparable postoperative patient outcomes and seizure control rate.


Conclusion
The SEEG is an evolving and safe surgical tool in both diagnostic and therapeutic application in epilepsy surgery.  Integration of neurosurgical robotic system into SEEG workflows represents a significant advancement in enhancing precision and scalability.

Stereotactic function neurosurgery has been evolving with the milestone development in radiology. From X-ray stereotactic intracranial localization, neurosurgeons have been using a head-frame to target the deep brain for lesions. With the invention of CT and MRI imaging, Neurosurgeons can proceed with sophisticate deep brain localization in precision, within 1mm in accuracy, with a head frame. Deep brain stimulation is the trailblazer in the discovery of deep brain function and therapy for movement disorders, ie Parkinson's disease. The challenges of achieving high precision together with patient comfort, ie discomfort by the head frame, is mounting. The development of intra-operative MRI imaging is riding on this challenge. Teams in hospital authority are seizing the opportunity, the era of intra-operative MRI, to tackle this challenge.

The introduction of the first intraoperative computed tomography (iCT) scanner at Prince of Wales Hospital (PWH) in Hong Kong represents a transformative advancement in neurosurgical and spinal surgery, significantly enhancing patient safety and quality of care. Intraoperative CT imaging provides real-time, high-resolution anatomical visualization during surgery, allowing for immediate verification of surgical accuracy and adjustments before wound closure. This technology minimizes the risks of misplaced spinal instrumentation or unintended neural damage, thereby reducing postoperative complications and revision surgeries.


For neurosurgery, iCT ensures precise localization, particularly in complex cases such as complex spinal tumor resections or deep brain stimulation, where millimeter-level accuracy is critical. In spinal surgery, it enhances the safety of screw placements in deformity corrections and spinal fusions, mitigating the risks of neurological injury or hardware malposition. By eliminating the need for postoperative scans to confirm surgical outcomes, iCT streamlines workflow, reduces anesthesia time, and shortens hospital stays, improving overall healthcare efficiency.


At PWH, the adoption of iCT reflects a commitment to cutting-edge, patient-centered care. The technology supports multidisciplinary collaboration, enabling Neurosurgeons, radiologists, and anesthetists to make data-driven decisions in real time. Ultimately, the integration of iCT at PWH underscores the hospital's dedication to optimizing surgical precision, enhancing patient outcomes, and setting new standards for safety and quality in neurosurgical and spinal interventions.