Chapter 335 Perfect removal, perfect recovery!
The patient's tumor is so small that the lesion may not be shown on the CT scan, whether now or in a few weeks.
Even for MRI, Zhang Hao needs to put down all other work and spend several hours desperately searching in the pineal area to find abnormalities.
If Xu Qiu hadn't reminded him and locked on a small area, Zhang Hao would not have been able to find it.
At this time, relying on comparison to judge whether it has deteriorated or not, first, the lesion is too small and no changes can be seen at all.
Second, Tao Changhan's neurological pathological manifestations have become more and more serious in the past few days. It is hard to say whether he can survive three weeks of marginal radiotherapy alone.
The most important point is that the patient's pineal brain tumor is slightly higher than the edge of the cerebellar tentorium, which is very insensitive to radiotherapy and chemotherapy.
In short, there is no other way except surgery!
This also made Zhang Hao quite desperate.
The hand holding the phone was a little cold.
He glanced at the computer.
In the group chat, Han Jinxing, Wei An and others all expressed their opinions.
All of them thought that the risk of surgery was extremely high and there was no point in surgery. They could only do palliative treatment and try simple chemotherapy to see if the patient's luck would be good.
Some people also thought that they could prescribe Chinese medicine prescriptions to see if they could save this kind of tumor that was in a tricky position and could not be cured by surgery or chemotherapy.
Based on Zhang Hao's clinical experience, he also thought that surgery was impossible.
But Xu Qiu didn't think so.
His calm voice came from the phone, saying: "Director Zhang, get ready, and we will have a joint consultation with neurosurgery, oncology, etc. in the afternoon."
"Joint consultation?"
Zhang Hao was stunned and shocked: "Doctor Xu, are you going to use surgery?"
"If you don't, let the patient wait to die?"
Zhang Hao's throat moved twice.
He wanted to say, "If you don't use surgery, the patient will wait to die; but if you use surgery, the doctor will kill the patient himself."
However, facing Xu Qiu, he stopped talking and said, "You want to form an MDT (multidisciplinary, multi-department) team?"
Pineal brain tumor is a serious matter that cannot be completed by a single doctor, and even people in a single department cannot handle it.
Only a multidisciplinary team can adapt to the ever-changing and thrilling pineal brain tumor surgery.
"Yes."
"Yes..." Zhang Hao was stunned.
Why can Xu Qiu answer such a difficult operation so easily?
This is a pineal brain tumor. Whether it is difficult or dangerous, it is much more difficult than the previous huge meningioma.
It is different from the cranio-cerebral separation surgery.
The difficulty of cranio-cerebral separation surgery lies in separating brain tissue and establishing two different brain nutrition systems.
The difficulty of resection of pineal brain tumor is to remove a tumor from an extremely deep and dangerous place.
If we really want to analyze it from a technical level, cranio-cerebral separation is naturally the most difficult one;
But in terms of risk, pineal brain tumor is not much less.
In short, there are not many leading medical oncology hospitals that can perform this operation.
"Okay, I will prepare for a joint consultation." Zhang Hao said.
He glanced at the group chat and found that Han Jinxing and others were tagging him again.
Han Jinxing: "I heard that Dr. Xu likes to challenge this kind of difficult operation. If he performs this pineal brain tumor, call me."
Wei An: "And me. Handshake.jpg."
After reading it, Zhang Hao said: "Doctor Xu, two deputy directors from other hospitals also want to come and observe the operation. What do you think..."
"Come all."
Xu Qiu's answer was still very brief.
The more people who come, the more important they are, and the higher the success rate of his operation.
He naturally couldn't miss this opportunity.
...
At five o'clock in the afternoon, just before getting off work, a temporary multi-disciplinary and multi-departmental joint consultation was held in the emergency department.
Among the participants was Jin Yucheng from the neurosurgery department.
He is a rising star in the Department of Neurosurgery of Linhai First Hospital. After Xu Qiu established the neurosurgery base, he quickly mastered the essentials and switched from neuroendoscopic surgery to the more sophisticated field of intracranial separation, thereby mastering a large number of high-precision techniques and methods for cranial and brain surgery.
Now he is no less inferior to Director Lin, and is a skilled surgeon who is in great demand.
In addition, the directors and deputy directors of the Department of Oncology, Department of Imaging, Department of Anesthesiology, and Department of Vascular Surgery were all present.
In addition to these family members, there were four or five people who came from other hospitals, such as Han Jinxing and Wei An.
This joint consultation finally ended at 6:17.
According to the pathological results, the consultation was initially diagnosed as medulloblastoma (WHO, grade IV, classic type).
Afterwards, Xu Qiu proposed a more rigorous surgical plan.
To put it simply, it is Poppen's operation into the third ventricle and pineal region tumor.
There are two conventional approaches to pineal brain tumors.
One is the approach from the infratentorial cerebellum, which is also the most common approach.
The second is the posterior longitudinal fissure. There are relatively few drainage veins from here. As long as the operation is gentle, the possibility of tearing the vein is very small.
However, Xu Qiu chose a rare approach.
Passing through the occipital region, entering the third ventricle and pineal region from the cerebral tentorium.
This procedure is more difficult and requires a lot of attention.
For example, when it pulls open the occipital lobe, it may damage the visual cortex.
When the cerebral tentorium is cut, the trochlear nerve in front may be damaged.
In addition, since no one knows what Tao Changhan's tumor looks like and where it originated, the direction of the final displacement of the lesion is also different.
If the tumor is covered by thickened arachnoid membrane, it is necessary to cut the arachnoid membrane additionally, and the great cerebral vein will be injured if you are not careful.
What is more dangerous is that when the tumor is peeled and removed, the internal cerebral vein, basal vein, and many branches are intricately distributed among them. It can be said that a single cut can detonate countless "mines" that are enough to cause death.
"Why choose this approach?"
In the conference room, whether it is Jin Yucheng, Zhang Hao, Han Jinxing, Wei An and others, their faces are very serious.
Xu Qiu gave an explanation:
"If you approach from the cerebellum, the great cerebral vein will inevitably be blocked, affecting the surgical field and operating space.
As for the posterior longitudinal fissure, the tumor is located lower. If this approach is used, although the risk is small, the surgical path will be lengthened, and the patient's injury and operation time will increase."
The former limits the performance of the main surgeon, which is equivalent to limiting the upper limit of the surgical effect.
The latter reduces the risk of death, but increases the minor injuries during the operation, which is considered to be stepping on the lower limit of "the patient does not die" to perform the operation.
The chances of survival are very high, but whether you live well or not is up to fate.
The Poppen surgery for tumors in the third ventricle and pineal region chosen by Xu Qiu abandoned all of this and left the surgical results completely to the personal ability of the surgeon!
If performed well, it would be perfect resection and perfect recovery.
However, if the scalpel deviates by even a little bit, there will be no guarantee measures, and the patient can only face death!
