Chapter 567 Three-hole positioning, incredible operation
"Two minutes and fifty-seven seconds?!"
Everyone took a deep breath, and time seemed to freeze. Everyone's eyes were fixed on this astonishing number, and their expressions were full of disbelief.
To complete such a complicated craniotomy within three minutes...even the craniotomy machine may not be able to achieve this speed!
"How can it be?"
"Did the timer start just halfway?!"
The equipment nurse, anesthetist, and others couldn't understand that the doctor's speed actually exceeded that of the craniotomy machine?
This is a craniotomy for brainstem hematoma removal...
The skull base is covered with irregular chondrified bones, and the posterior cranial fossa is very small. The lower part is connected to the spinal canal through the vertebral foramen magnum, and the lower part is separated from the brain by the cerebellum. There is an oval cerebellum hole in the front, and the shape is nearby. There are key structures such as the trigeminal nerve, internal carotid artery, second to sixth pairs of cranial nerves, ophthalmic artery, and middle meningeal artery.
In addition, craniotomy in the posterior cranial fossa can easily cause bleeding, such as the suboccipital muscles, the conductive vessels next to the midline of the occipital bone, the retromastoid conductive vessels, the suboccipital venous plexus, etc...
However, Xu Qiu completely controlled the rhythm of the entire operation in just three minutes, leading Mo Wan and Tang Yunshu to complete the craniotomy at an incredible speed.
"It's simply... unimaginable!" The anesthesiologist was shocked.
He has performed many surgeries at the Brain Surgery Department of the First Affiliated Hospital, and some of them involved bleeding in the brainstem area of more than ten milliliters. However, the craniotomy took more than five minutes, and all the doctors were afraid to speak out during the entire operation. .
But what’s going on now…
Craniotomy for brainstem hemorrhage suddenly seems simple.
First simply open a cranial window, then cut the dura mater with a few cuts, and then...done? !
…
"continue."
Xu Qiu took a deep breath.
three minutes……
Although this speed is not slow, it does not reach his limit.
The master-level craniotomy gave Xu Qiu clinical intuition, surgical touch, and... control over the entire operation that were far beyond ordinary people.
All the tedious operations were streamlined to three minutes. Everything seemed to be as fast as lightning, but Xu Qiu still made a lot of small designs.
One of the difficulties in posterior fossa surgery is cranioplasty.
The curvature of the bony surface of the posterior cranial fossa is too large, and it is deeply embedded in the posterior occipital muscles. On the one hand, it is difficult for the surgeon to operate smoothly in this area. On the other hand, the lower part of the bone flap is closely connected with the venous sinus. , it is easy for sinus injury and bleeding to occur.
The patients whose skulls enter from here are often in critical condition, such as today's patient No. 2 - if there is another venous sinus bleeding, it is almost like driving a rocket on the road to visit the King of Hell.
Therefore, Xu Qiu made many detailed improvements based on the patient's own situation.
The first is drilling.
Before, Tang Yunshu and Mo Wan only saw his motionless hands.
For laymen, what they can see and reflect the skill of the surgeon is whether the hand is not shaking and whether the point of opening the hole is accurate enough.
In fact, Xu Qiu specially selected the junction of the lower edge of the transverse sinus and the sigmoid sinus to drill the first hole.
The second hole is three centimeters away from the first hole and just below the upper nuchal line. This position can expose part of the transverse sinus.
The last hole is located above and below the condylar vein.
This drilling point just needs to use the stereotaxic projection line method mentioned in Xu Qiu's lecture. The inner side of the projection of the lower edge of the sigmoid sinus and its junction is the most suitable third hole location.
Xu Qiu's three-hole method can effectively expose the edge of the venous sinus.
To put it simply, it is human body tracing.
By being able to clearly see where the sinuses are, the risk of injury during surgery is naturally minimized.
Moreover, the scope of the bone window opened by the three holes happened to be the smallest area and the best surgical field that could accommodate Xu Qiu's subsequent hematoma removal surgery.
All this sounds simple, but in practice, it is difficult to practice even with a craniotomy machine.
Isn’t foramen No. 1 the junction of the lower edge of the transverse sinus and the sigmoid sinus?
But in fact, the anatomical variability of this place is very large. The lambdoid suture, parietal mammary suture, occipital mammary suture, etc. are distributed and intersected, and the various positioning marks also vary greatly. It is not easy to accurately find the positioning point of hole No. 1. Easy things.
For the remaining two hole locations, the relative distance must also be estimated based on hole No. 1 to perform indirect positioning.
For example, in the three-hole method, part of the posterior edge of the mastoid needs to be ground away between the first and third holes to form a bone groove connecting the two bone holes. The bone groove is only in the extremely thin skull. plate.
And here, it is necessary to locate the mastoid tip and the junction of the squamous suture and the parietomastoid suture, and then extend it in a straight line to find the projection of the ascending segment of the sigmoid sinus, and use the projection to carry out the next step of dural separation, etc...
Therefore, unless the No. 1 hole can be found accurately, Xu Qiu's three-hole method will be counterproductive... Once the No. 1 hole is missed by a hair, the other two holes will also be wrong by thousands of miles!
If Director Zhu and Director were here, they would probably be shocked and speechless.
The scariest thing is not that Xu Qiu can accurately locate these places.
If Director Zhu, Chief Director and others were on stage, they might be able to do it.
but……
They need time.
The positioning of each place takes a few minutes just to get the rough range, and then to lock it in detail. It may take more than ten minutes to finally complete all of this before you have the confidence to use the knife.
But Xu Qiu completed all this in three minutes, and even completed the craniotomy!
However, Mo Wan and Tang Yunshu only saw that Xu Qiu's hands were very steady and fast, and they were very comfortable with the craniotomy...
Not being experts in brainstem hematoma removal, they calmed down and just silently followed Xu Qiu's orders, silently shouting 666 in their hearts.
...
Hua La——
Xu Qiu's movements continued to accelerate.
After opening the dura mater, the following operations were much simpler.
Of course, it was only simple in terms of the operation coefficient, which was nothing more than decompression, elimination of hematoma, suction of bleeding, and retraction if there was brain herniation, and finally hemostasis.
However, the risk was much higher than the craniotomy step.
As a former brain forbidden area, the brainstem was a field that only a very small number of elite doctors were qualified to get involved in.
Draw cerebrospinal fluid...
Gradually open...
Enter the cerebellar meninges...
Then, expose the cerebellar meningeal margin and trochlear nerve, while avoiding Labbe vein, trochlear nerve, etc....
Under the microscope, the patient's midbrain pontine sulcus, superior cerebellar artery and other structures are revealed.
At this step, Tang Yunshu and Mo Wan's hands are a little stiff.
At this time, the doctor's thought difference can determine the patient's life and death. If the hand is slightly off by one millimeter, the consequence for the patient may be death!
