Chapter 3182 【3182】Superposition of Difficulty

Therefore, doctors are required to keep the operation process smooth and not to poke the wrong place or cause bleeding, otherwise it will become a medical accident.

To keep the whole process smooth and without obstacles, and to reach the target lesion without getting lost, the doctor must first find out the way to go, just like driving a car.

How to take this surgical approach, like other types of surgeries, there are conventional practices (if you use a car map to navigate when driving), you have the experience of colleagues and your own surgery to accumulate (other drivers teach you experience or you have driven this kind of road yourself) experience as a basis).

There are two conventional positions for transnasal transsphenoidal approach, one is supine position and the other is semi-sitting position.

Just by looking at the patient's position in the latter, you will know that the patient's supine position in the former cannot be a horizontal supine position, but can only be a supine position with the head high and the feet low.

This is determined by human anatomy. The anatomical path of the transnasosphenoidal approach has been discussed before. It enters the brain through the nasal cavity and through the special anatomical opening of the sphenoid sinus.

Compare gastroscopy and colonoscopy.

Gastroscopy and colonoscopy are the doctor's tools, like a snake walking around in a tunnel. There is an advantage to walking in the tunnel. If you go wrong, retreat and advance. As long as you don't hit the wall, there is no high risk.

Rhinosphenoidal surgery is not like this. After passing through the sphenoid sinus, the surgical instruments are directly inserted into a ball of "tofu". Since there is no tunnel, the "tofu ball" needs to be moved back and forward again. It is very easy to accidentally injure the surrounding areas. "Tofu brain".

However, these adjacent "tofu brains" that are easily injured by accident are particularly important in anatomy, so the sequelae of surgery are particularly terrible.

If the position is wrong, if you run down and hit the brainstem, you may die directly from the brainstem if you are not careful.

When it was moved higher, it hit the damaged optic nerve and blinded the patient.

If it deviates from the midline and pierces the cavernous sinus and internal carotid artery, massive bleeding during the operation will inevitably lead to death.

In order to avoid these horrific incidents from happening, the best way is for doctors to reach the lesion in one step without having to explore again after entering the "tofu brain".

To achieve this, the doctor needs to find the correct entrance angle of the sphenoid sinus and accurately operate the "tofu brain", both of which are indispensable.

Previously, doctors could use neural 3D navigation software to calculate angles based on imaging films.

To do it later, it is too difficult to just ask the doctor to adjust the angle with tools.

If it is difficult to understand, it can be compared to using a long-handled cup at home to make a strange-shaped cup with a narrow mouth and a long mouth. If you want to clean the stubborn stains at the bottom of the cup, but the brush can't reach it, you have to plan early to adjust the angle of the cup so that the cup brush can easily reach the bottom.

Adjusting the cup angle is equivalent to adjusting the patient's head position in neurosurgery. Therefore, the transnasal sphenoidal surgery mentioned above inevitably requires a head-up position and a low-foot position. The specific height of this head height will test the doctor's previous calculation.

Not all doctors can calculate it accurately, and more clinicians use a large number of clinical mice to practice and make sacrifices to accumulate experience points.

Doctors with extremely high IQs can do calculations without using mice. Unfortunately, doctors who can achieve this perfect goal are rare.

"Only one operation position?"

(Is there only one surgical position?)

Dr. Charlie raised his finger to Dr. Tong to verify whether it was really the same position throughout the operation.

As mentioned above, it is difficult for good doctors to determine the entrance angle of the sphenoid sinus during transnasal sphenoidal surgery. The determination of the transcranial surgical approach has been described in many surgical examples before, and it is equally difficult.