Chapter 209 A dead end, an unsolvable surgical dilemma!

In medicine, craniopagus conjoined twins are actually quite rare, with an incidence of about 0.6 per million in newborns.

Because there are so few cases, there are few records of craniopagus fusion, treatment guidelines, etc. at home and abroad.

The classification is also very rough, with only partial fusion and complete fusion.

Partial fusion is simply the connection between the skin, the brain and the dura mater.

This separation is actually very simple. The brain tissues of the two people develop independently and do not affect each other. Just saw off the bones.

Later, they are filled with artificial materials. After they grow well, except for the part where hair does not grow, they are basically no different from ordinary people.

But the bad thing is that Siping and Si'an are completely fused.

Their subdural blood supply and brain tissue are connected together, and the sagittal sinus is shared.

Although the MRI examination showed that the brain tissues of the two people were not fused and shared, the information provided by cerebral angiography was not optimistic.

The cerebral arteries and veins of the twins cross-supply blood!

The 3D printed model shows it more clearly-the anatomical structure of the superior sagittal sinus is fused together!

Clinically, there is no precedent for the separation of conjoined twins with shared sagittal sinuses...

Gao Denggui sighed, "This pair was sent to our hospital shortly after birth.

We formed a medical team of more than 30 people at that time, and neurosurgery, plastic surgery, anesthesia, neuroimaging, neonatal ICU, etc. all participated in the discussion of the surgical plan.

Before that, we had tried to make preoperative preparations."

Xu Qiu nodded.

Indeed, Jinghai City has done a lot of work here.

The separation of the skull and brain is by no means a one-shot cut.

It is like a marathon, which takes a long time and has a large span. The operation needs to be carried out in stages and the separation is completed step by step.

When the baby was three months old, Jinghai People's Hospital performed a strip skull resection to cut off the skull of the two conjoined babies.

Afterwards, an in vitro traction device was designed and produced based on the 3D printed model.

It was originally expected to take three weeks to pull the skull at a rate of 2.0mm per day to stimulate the growth of the skull and soft tissue.

As a result, the twins were interrupted early due to pressure ulcers on their heads after one week.

This was also the direct reason for announcing that the operation was extremely difficult.

Even if it was carried out according to plan, it would be difficult to save the lives of the two babies, not to mention that accidents kept happening in the middle.

The hospital's plan was to give up one and try to save the other.

However, the reality was that even the one who survived was likely to face the risk of blindness, paralysis, or even death on the operating table!

…

Click.

Finally, Xu Qiu finished reading this thick stack of information and heaved a sigh of relief.

The patient's condition was worse than he had imagined.

The biggest difficulty in doing cranio-cerebral separation was that although Siping and Si'an each had an independent brain, they were both deformed.

The right hemispheres of the two people's brains were squeezed and extended upward, like tofu blocks close together, sticking together.

In addition,

there were a large number of shared arteries and veins in the parts where they grew together, and the anatomical structure of the superior sagittal sinus was completely shared.

If you want to separate them, you must redistribute these arteries and veins.

The most critical problem is that there is no way to separate the shared sagittal sinus.

Gao Denggui sighed quietly.

Xu Qiu was only talking about the difficulties in surgical operation.

In addition, anesthesia is almost unsolvable.

Conjoined twins have serious blood supply problems, which will not only lead to abnormal drug effects, but also unexpected blood pressure abnormalities.

Blood transfusion, infusion, and medication are all uncontrollable. After the drug enters the body, it is very likely that one side has high blood pressure and the other side has low blood pressure, making it difficult to balance the medication.

Among them, any mistake in any detail will cause the already fragile conjoined twins to die on the stage.

In short, this is a dead end.

However, at this moment, Xu Qiu, who had just put down the information, spoke again: "If the sagittal sinus cannot be separated, then don't separate it."

Gao Denggui nodded: "We think so too. Just give up one and leave the sagittal sinus to the one who has a chance to survive."

Xu Qiu said to himself: "What I mean is to establish a venous shunt circuit."

Since it can't be separated,

then simply establish a new venous channel to give the patient hope of survival with human power!

Gao Denggui was stunned for a long time before he realized what Xu Qiu was going to do: "You mean... perform a cranial brain separation operation to save two babies? This is impossible!"

Establish a venous circuit?

Even the experts at Tiantan Hospital dare not say that they can do this technology!

Besides, even if they can do it, what does it matter?

This is not connecting a water pipe. Just buy a new one and you can pass water as long as it is matched.

The veins in the brain flow blood every moment, maintaining consciousness and life-how can you say that reconstruction can be rebuilt!

Xu Qiu took out the patient's 3D model and angiography results.

In order to avoid confusion of names, Xu Qiu marked No. 1 and No. 2 on it.

Then he pointed to one of the places and said:

"The high-speed drill goes in from here, into the skull, and creates a new venous circulation for patient No. 1. The separated blood vessels and sagittal sinus are given to the more fragile patient No. 2.

As for the new circulation, it will be cut from the thigh of patient No. 1..."

Xu Qiu calmly narrated his plan.

Gao Denggui was completely impressed.

He didn't know whether Xu Qiu was really capable of doing it, but this idea had already solved the unshareable sagittal sinus problem.

"So, what about anesthesia? How to coordinate the anesthesia between the two?" Gao Denggui asked again.

This is actually something that the anesthesiology department should consider.

Xu Qiu didn't mind. After thinking about it, he gave the answer:

“Take the medicine based on the weak Patient No. 2.

The two groups of anesthesiologists performed anesthesia at the same time, lying on their sides with intubation and inhalation to administer drugs, preferably shallow rather than deep.

In addition, two sets of monitoring measures include invasive detection and real-time dynamic monitoring of hemodynamics.

I would resolve the problem of vascular separation and circulatory crossing as quickly as possible to avoid hypovolemic shock caused by blood stealing. "

Gao Denggui was silent.

The other party seemed to have thought about everything a long time ago and was determined to win the brain separation surgery.

but……

Is it really possible?

Is it possible that Xu Qiu alone is more professional than the evaluation of the entire Tiantan Hospital expert team? !

When everyone was silent, Tang Yunshu took a deep breath and said, "Director Gao, you may not have seen Xu Qiu's abilities. But if he thinks he can do it, I will choose to believe him."

Gao Denggui looked shocked.

How could this irritable expert who once kicked open the conference room door have such a soft attitude when it came to Xu Qiu?

He couldn't figure it out.

What is it about a twenty-four-year-old doctor that makes so many people praise him so much?

"Okay, if you want to do it, I can take you to communicate with your family, but if something happens, you will be responsible." Gao Denggui thought about it and relaxed.

The conjoined twins are now a hot potato. Taking into account the special status of the patient's ancestors, the provincial government insists on saving the lives of the two babies, but does not consider the medical difficulties at all.

Xu Qiu took the initiative to ask for help, and their hospital could use this to absolve some of its responsibilities.

On the other side, Xu Qiu didn't have so many ideas.

He constantly simulates the structure and distribution of new venous circulation, perfecting the most critical steps of this operation.

Master-level cranial venous circuit reconstruction surgery played an unexpected role at this time.

After the meeting, Xu Qiu followed Gao Denggui and contacted the patient's family, who finally agreed to Xu Qiu's surgical plan.

For the family members, they didn’t understand anything about sagittal sinus or vein reconstruction. What made them make this decision was Xu Qiu’s white coat.

The operation was scheduled for the morning of the next day.

After learning that he was going to undergo a craniocerebral separation operation, the entire Jinghai People's Hospital was in a state of excitement.

Many doctors in brain surgery begin to regret it.

Just because they refused to attend that academic conference, they also lost the opportunity to observe the surgery.

This is the only case in the world of extremely difficult brain separation surgery for conjoined twins!

Some brain surgery experts in the industry once said that brain separation surgery is the basis for head transplant surgery - when one day ordinary doctors can also master brain separation surgery, perhaps the birth of head transplant surgery will be the basis of the era.

One can imagine how incredibly difficult it is to separate a completely fused brain!

This is also the biggest challenge Xu Qiu has faced since starting his career.

However, that afternoon, the development of this matter exceeded Xu Qiu's expectation...