Chapter 569 No operation is redundant

From the whole operation, Xu Qiu is almost a detail maniac. He has done impeccable work in every step of the operation... and such a person is likely to be a perfectionist, or a morbid obsessive-compulsive maniac.

The other party may really do meaningless repairs for the sake of postoperative beauty.

The anesthesiologist subconsciously reminded:

"Doctor Xu, the director of our first affiliated hospital has done a lot of research and discussion on whether to connect the skull bone window after surgery...

"Finally, it is concluded that as long as the hematoma is completely removed and the bleeding is properly stopped, combined with the use of postoperative dehydration drugs, the incidence of postoperative cerebral edema is very small; simple bone flap reduction, although without blood supply, can still play a basic protective role, and the chance of deep infection will not increase..."

His words are very euphemistic.

But the meaning is quite clear: whether to connect the skull or not will not help the postoperative recovery of the disease, except To improve the aesthetic effect, there is no greater meaning.

The skull connecting piece is a foreign body after all, so it is not necessary.

Moreover, if a second operation is required, the open bone window can increase the error tolerance. Once the connecting piece is embedded in the skull, the skull will have to be opened again.

…

Xu Qiu's movements did not stop at all, as if he did not hear the anesthesiologist's reminder.

He slowly fixed the connecting piece in the groove of the skull drill, and adjusted it slightly, finally making its upper surface flush with the skull surface, and one side of the bone flap fits tightly with the intact skull to minimize bone absorption.

"Bone cement. "

Xu Qiu continued the operation.

A standard milling cutter can open about two centimeters of skull along the cranial line, and the subsequent connection is carried out according to the above method.

However, it only targets the top and frontal skull.

The temporal and occipital parts are covered with a lot of muscles and are relatively more active, so bone cement must be used to fill them, otherwise the bone gaps will become larger and larger.

After more than ten minutes, when the skull connection operation was about to end, Xu Qiu finally spoke to answer the doubts of the anesthesiologist and others.

"The mainstream view is that the craniotomy of the bone window in the posterior cranial fossa does tend not to be repaired, and it is believed that putting the bone flap back can only improve the appearance.

"But this is wrong."

The pupils of the anesthesiologist and others shrank slightly. They instinctively felt that this was too ridiculous - in the Affiliated Hospital No. 1, which is famous for craniotomy, it is absurd to say that their theory of brain surgery is wrong.

But they didn't dare to say this... The doctor in front of them, whether in terms of surgical ability, skills, or experience in surgery, far exceeded Director Zhu, who was the only one in the department.

Moreover, he was performing the operation with two laymen!

"Wrong... How could it be wrong?" The anesthesiologist's voice sounded low. He wanted to question, but when he saw Xu Qiu's calm eyes, he was suppressed by the other party's calm temperament, and his voice was also cautious.

Xu Qiu gave the answer: "There are many craniotomies in the first hospital, and there should be many patients in the posterior cranial fossa. What is the prognosis of these patients?"

The anesthesiologist said like a treasure: "Prognosis? The success rate is very high! Especially for hypertensive patients, our first ward simultaneously carried out bone craniotomy decompression hematoma removal, small bone window minimally invasive craniotomy hematoma removal, hematoma crushing and aspiration and dissolution, etc. The average mortality rate in the industry is about 80%, but we can control it below 10%, which is already at the international advanced level."

After that, the nurses in the operating room also raised their chins slightly, feeling proud of it.

Xu Qiu asked more directly: "I mean, are there any common complications, side effects, etc. after surgery?"

"Common complications? There shouldn't be, the patients all recovered well."

Xu Qiu said without emotion: "Headache counts."

"Wait... Headache counts, isn't that a sequelae that will appear after posterior fossa craniotomy? Is that also... a problem?" The anesthesiologist was shocked.

Xu Qiu slowly said a wise saying: "It has always been like this, so it is right?"

"This..."

While Xu Qiu was connecting the final bone flap, he said: "The mechanism of postoperative headache is actually the adhesion between the occipital and cervical muscles and the dura mater, which causes any movement of the patient to cause muscle contraction and traction, which in turn causes headache.

"If the bone flap is repositioned and the skull is connected, the adhesion between the muscle and the dura mater will be avoided to the greatest extent.

"Of course, if you want to completely eliminate headaches, there is another key factor - surgical injury and infection control.

"If the operation cannot be strictly controlled, the greater and lesser occipital nerves may be damaged, and the fragments of the skull will enter the subarachnoid space. It is only a matter of time before aseptic inflammation occurs..."

Xu Qiu explained calmly.

The anesthesiologist and the nurse were stunned. Headaches are directly related to bone flap reduction and skull connection?

This is a conclusion they have never heard of. The director of the First Affiliated Hospital, Director Zhu and others have never had similar experiences, and no one in the First Affiliated Hospital has thought deeply about the root cause of headaches.

The anesthesiologist said silently: "If it is just a headache, it will not affect anything. It can be solved with some painkillers... Just to avoid headaches, it is not a bit too cost-effective to do a bone flap reduction?"

This is in line with Xu Qiu's personality - let the patient be healed comfortably.

Xu Qiu shook his head.

Many doctors in clinical practice ignore pain, thinking that it can indicate changes in the condition and often do not treat it. However, only those who have really experienced pain can understand that pain is far more torturous than other symptoms, and it is definitely not something that can be dealt with by a doctor's casual remark of "just bear with it"... and its impact on the patient's mentality is also one of the decisive factors in the postoperative recovery effect.

Of course, if it is just to relieve headaches, Xu Qiu will not reposition and connect them in a big way.

He said briefly:

"Relieving headaches is only the most intuitive manifestation. In addition, the repositioned bone flap can also reduce the dead space between the occipital and cervical muscles and the dura mater, preventing patients from coughing after surgery and causing periodic intracranial elevation."

This is a very scary situation. When coughing, the suture site swells up subcutaneously, which is still a mild case. In severe cases, it can also cause cerebrospinal fluid leakage, etc., and even directly cause bulging of the meninges.

"The second is the protective effect.

"In addition to providing a physical barrier to the occipital cerebellum, the repositioned bone flap is also a measure to control changes in cerebrospinal fluid, blood flow and brain metabolic needs. Many patients who undergo hematoma removal and craniectomy have a high risk of developing drilling syndrome, and one of the biggest causes of the disease is the failure to close the skull! "

Gradually, the anesthesiologists and others could no longer understand.

Xu Qiu's lectures were gradually approaching advanced specialized knowledge. They were either from the operating room or the anesthesia department. How could they understand the mechanism that the director and others had not figured out?