Come on, Dr. Wu

Chapter 305 The only one who can surpass Wu Xiaofu is Wu Xiaofu himself!

There is no doubt that intracranial aneurysm is one of the most difficult operations in neurosurgery. The reason is simple: aneurysms can easily rupture during surgery, and once an aneurysm ruptures, well, we all know the consequences.

There are currently two main treatments for intracranial aneurysms: craniotomy and clipping and interventional embolization.

Of course, which method to use depends on the situation.

Neurosurgeons treat patients with intracranial aneurysms mainly by formulating corresponding treatment plans based on the morphology and location of the aneurysm, the patient's age, general condition, and status after onset of the disease.

Craniotomy and clipping is to select the appropriate aneurysm clip to clip the aneurysm based on the direction of the aneurysm, the length of the aneurysm neck, etc., so that the blood in the blood vessels no longer enters the tumor.

Interventional embolization is an external puncture in which a microcatheter is inserted directly into the brain tumor, and then a microcoil is pushed in for packing to stop blood from entering the aneurysm.

The advantages of craniotomy and clipping are that the recurrence rate is very low, the hematoma can be removed at the same time, it is suitable for patients with large intracranial hematomas, and the cost is low.

The disadvantage is that it is a craniotomy, which is very traumatic and has high requirements for the operator.

This is the current situation. Patients can choose minimally invasive surgery. Who would want to undergo major surgery? Moreover, patients don’t know much about it. In their minds, a small incision is always less risky than a large one.

Therefore, there is an interventional embolization surgery with less trauma and quick recovery.

However, the disadvantages of interventional embolization are also significant. It is expensive and has a higher recurrence rate than craniotomy. Many aneurysms after interventional embolization will form again, and repeated surgeries are required, which is not only costly but also increases the risks.

Therefore, there has always been controversy in neurosurgery regarding the use of the two surgical procedures.

However, the specific surgical procedure to be used ultimately depends on the doctor.

Because although the doctor will tell the patient the pros and cons of the two surgical procedures, the patient still has to listen to the doctor's advice on which one is suitable.

John's choice was simple: open the skull.

Choosing the more difficult craniotomy may be due to John's confidence in himself, but it is also a requirement of the surgery, because the difficulty of this operation is indeed high.

Continuous aneurysm.

There are three consecutive aneurysms on the intracranial artery, and the risk of interventional surgery is too high. There may be some connection between the three aneurysms. After one is embolized, will it have any impact on the other two and cause the other two aneurysms to rupture directly!

This is an issue that must be considered.

Moreover, if the aneurysm ruptures after craniotomy, it may be possible to recover. However, if something goes wrong during the intervention, it will be difficult to recover.

John's choice undoubtedly made many people nod in approval.

The difficulty of this operation is even higher than that of Huang Feng. It is definitely impossible to complete it within an hour.

Wu Xiaofu was somewhat curious about how these three consecutive aneurysms were formed.

You should know that the main cause of intracranial aneurysm formation is actually mostly due to unstable blood pressure and poor dilation and contraction of blood vessels for a long time. If something goes wrong one day, a bulge will occur directly. However, this kind of continuous aneurysm generally does not occur in such situations.

Especially an aneurysm that is so stable and has never ruptured.

Although Wu Xiaofu is not a neurosurgeon, he has learned some related subjects.

Look at the patient's medical records.

According to the information, the patient is a 69-year-old male. Before being admitted to the hospital, he fell and was injured in his left eye by a tree branch, causing swelling and blindness of his left eye, and eyelid laceration and bleeding, so he was admitted to the hospital for treatment.

After reading this, Wu Xiaofu suddenly realized that it was a traumatic aneurysm!
This situation does exist. The eyes are the closest point to the brain. If the trauma is deep, it may directly damage the intracranial artery. Even if there is no direct damage, it may cause indirect compression and affect the normal circulation of the intracranial artery. In this case, an aneurysm may also occur at the compression site.

Not only this kind of obvious trauma, sometimes when you hit your head or get hit by a stick, you may feel pain at first, but then you don’t feel much and don’t pay attention to it. However, not long after, the intracranial artery may rupture. This may be the initial trauma that causes the intracranial aneurysm.

When the patient was first examined, no obvious problems were found, so the main focus was on dealing with the problem of the left eye. However, during the second routine follow-up, he suddenly had massive nasal bleeding accompanied by vomiting blood.

The hospital urgently stopped the bleeding and then transferred the patient to the neurology department for examination.

There was a problem with this examination. Considering the patient's injury process and symptoms, the neurologist considered that the patient had a traumatic pseudoaneurysm of the internal carotid artery and immediately completed a CTA examination of the head and neck.

The results indicated that it was multiple intracranial aneurysms. The aneurysm "branches" damaged the patient's intracranial arteries. The damaged blood vessel walls continued to expand cystically and bleeding occurred, which caused nasal bleeding and vomiting of blood.

In this case, there is naturally no time to delay and emergency surgery is required.

Now it is John's turn as the attending physician to decide on the treatment plan and perform the surgery.

Traumatic intracranial pseudoaneurysm is caused by trauma that leads to rupture and bleeding of intracranial blood vessels. The hematoma muscularizes into the tumor wall, thus forming an aneurysm that is connected to the blood vessels. The pseudoaneurysm formed in this way does not have a complete blood vessel wall structure and is prone to repeated rupture and bleeding.

Pseudoaneurysm lacks normal aneurysm wall structure and has the characteristics of late development, unclear aneurysm neck, unstable morphology and contrast agent retention on cerebral angiography. Therefore, it is also called "ghost aneurysm".

Well, just like this patient, if timely surgery is not performed, the risk of subsequent bleeding will become greater and greater. If it is really just treated as a nosebleed and not taken seriously, it may delay the treatment later, resulting in blood vessel rupture and heavy bleeding, and life-threatening.

Moreover, the rebleeding rate of pseudoaneurysm is high. Current medical treatments can only perform surgical clipping and interventional treatments, which can only remove the danger of the tumor but cannot restore the blood vessels to their original state. Therefore, the risk of recurrence is very high.

Compared with ordinary ruptured aneurysms, false aneurysms are more difficult to treat and have higher risks, so people's expectations for this operation are still very high.

Under the gaze of everyone, John opened the patient's skull. Some steps still required observation under a microscope.

Three pseudoaneurysms appeared clearly in front of everyone.

Clipping an aneurysm requires stability, accuracy and ruthlessness.

After completing the complicated preliminary work, John began to perform aneurysm clipping.

Aneurysm clipping is actually very easy to understand. It involves clipping the protruding aneurysm on the artery with a vascular clip. The reason these aneurysms continue to expand is because they are connected to the blood vessels and have blood supply.

After the clipping, blood no longer enters the aneurysm and no longer provides nutrients to the hemangioma. Gradually, these hemangiomas naturally shrink and then disappear.

The principle is simple, but it is difficult to do.

Nearly an hour had passed after the first arterial hemangioma was clipped, which shows how difficult the operation is. The more multiple hemangiomas there are, the more fragile the patient's blood vessel walls are. After all, blood vessels are elastic. If the blood vessel walls are not damaged and the elasticity is not damaged, how can hemangiomas occur?

Therefore, when clamping, you can't just clamp it directly as you imagine. If you are not careful, it is easy to rupture the blood vessel wall and cause heavy bleeding. However, after the first hemangioma was clamped, everyone breathed a sigh of relief.

All things are difficult at the beginning, and the same is true for continuous hemangiomas. Once the first hemangioma is clipped, the difficulty of subsequent clippings will be reduced and the progress will be accelerated.

One and a half hours after the operation began, all three hemangiomas were clipped off.

However, just when everyone thought the operation was about to end, John actually started to show off his skills.

Blood vessel wall repair!
Everyone was a little confused watching John's operation. As mentioned before, intracranial hemangioma surgery is one of the most difficult operations in neurosurgery. Now John is going to perform a vascular wall repair operation, which is even more difficult than intracranial hemangioma surgery.

After all, it is not easy to repair damaged blood vessel walls.

Some experienced directors will not perform such operations lightly. After all, if they are not careful, the operation may fail completely and may even affect the patient's life.

If the blood vessel wall is not repaired, the patient has a high chance of recurring hemangioma in the later stage. If you want to solve the problem once and for all, blood vessel wall repair surgery is a very effective procedure. Although it may not be able to completely eliminate the possibility of recurrence in patients, the possibility of recurrence of aneurysm will be reduced after the operation, and at least the time of recurrence will be greatly delayed.

But, John, is it okay?

There was an academician of neurosurgery at the scene, and he couldn't help but frown at this moment. John had finished the operation now, and it was undoubtedly a perfect operation. His score would definitely not be low. It might not necessarily surpass Wu Xiaofu, but it would definitely be higher than other neurosurgeons.

Now they are taking the risk of performing vascular wall repair surgery, I'm afraid it's aimed at Wu Xiaofu.

No, I'm afraid John had already thought of it a long time ago. He performed intracranial hemangioma clipping surgery followed by vascular wall repair surgery. If successful, there is a possibility that he might surpass Wu Xiaofu, but the risk is really too great.

But this is a game and no one is going to stop him.

The doctors in Country M were even more expectant. If they could surpass Wu Xiaofu, they would be extremely happy.

Sweat was dripping down John's cheeks at this moment, which showed how much pressure he was under.

Yes, as a neurosurgeon, who doesn’t install a few stents?

What do you think is the reason? Isn't it just too much stress? It's common for blood pressure to go up and down. As for sweat, it's healthier to sweat.

Staying up all night is nothing unusual.

呲!
A stream of blood blurred his vision. Wu Xiaofu seemed to have heard the sound of a ruptured blood vessel. Everyone was leaning on their chairs to watch, but now they all sat up quickly. The blood vessel wall was ruptured, and it was unclear whether it would be oozing blood or heavy bleeding.

Judging from the current situation, it should be bleeding, but if the bleeding is not treated in time, it will turn into heavy bleeding, so now, we must curb this situation as soon as possible.

Otherwise, the result of this operation is self-evident.

No matter how well John had performed before, this operation was a failure.

At the moment of bleeding, John obviously paused. When everyone saw this pause, they were all shocked. They knew that this was probably an unexpected situation in John's mind.

However, blood vessel wall repair and bleeding should be something that needs to be planned in advance for this type of surgery, so John should be prepared.

In fact, it is true that John has already started to deal with it in time.

However, due to the blood blurring John's vision, the difficulty of the operation increased significantly. After a minute, the situation had not improved, and the assistant even had to clear the field of vision more and more frequently.

Everyone watching the operation couldn't help but frown. This was not a good sign.

One minute may seem insignificant at ordinary times, but in surgery, especially in this surgery, if the problem cannot be solved, it will cause problems.

Drop drop!
There was a problem with the monitor. Everyone looked over and were shocked. There was a problem with the heart rate and blood pressure. John didn't have much time left.

call!
I don't know who let out a long sigh, but everyone in the audience heard it. No, everyone breathed a sigh of relief. The problem was solved. After the blood in the field of vision was cleared, the blurred vision was no longer there. It seemed that John had solved the bleeding problem.

Although everyone present is in competition, no one wants the patient to have problems. This is the medical ethics that every doctor should have, even if they are just simulating a patient.

Looking at the time, everyone realized that four hours had passed.

And now, John's operation is not even halfway through. Repairing the blood vessel wall is a big job and it is time-consuming. To be honest, this type of operation is a protracted battle.

The operation lasted a full seven hours before it was completed.

During the period, there were still some bleeding incidents like before, but it was all safe. However, how should I put it, watching the operation is like riding a roller coaster, not to mention the person performing the operation. To do this kind of operation, you really need a strong heart.

beep!

It's time to announce the results. After watching for so long, the moment we have been looking forward to has finally arrived. To be honest, John's vascular repair surgery was not as good as expected. There was too much bleeding. Although John solved all the problems, it was obviously the result of unskilled skills. The operation took seven hours, which was not even a quarter of the standard time.

Although the operation is difficult, no one knows how many points it will score.

Of course, it is definitely higher than simply completing intracranial artery clipping, but no one dares to say whether it is better than Wu Xiaofu.

Therefore, everyone was even more looking forward to it at this time.

After all, this is the greatest hope.

John did the same, staring at the machine screen closely.

One hundred and seventy-nine points!
Looking at the score, John finally gave up. One hundred and seventy-nine points was really high, but it was still quite a distance from Wu Xiaofu's one hundred and ninety points, especially since John didn't even cross the threshold of one hundred and eighty points.

This was the second highest score at the scene, even much higher than the third place, but there was not much joy on John's face.

In his opinion, no matter how high the score is, it is meaningless if you are not the champion.

In this world, no one will remember the second place.

Everyone looked at Wu Xiaofu with complicated expressions. In this competition, the only one who could surpass Wu Xiaofu could be Wu Xiaofu himself.

After all, tomorrow is the last subject of the competition, hepatobiliary surgery.

(End of this chapter)