Doctor: It's reasonable to perform surgery on yourself.

From the current situation, the incidence of endolymphatic sac tumors in children is too low.

The same is true for glomus tumors. It is a rare disease that occurs in the rare middle ear. The possibility is not lower than winning the lottery by buying consecutive numbers, but it is almost the same.

The more likely possibility is cholesterol granuloma.

However, even the seemingly reasonable cholesterol granuloma cannot explain the patient's series of abnormalities.

But at this time Xu Qiu shook his head.

He looked at the pediatrician and said, "You don't see the essence of these symptoms."

The essence...

This sentence stunned the pediatrician.

Xu Qiu didn't want to keep it a secret, and said bluntly: "Resistance to dressing and undressing, and inability to hold a toothbrush are actually the same reason... inability to shrug."

The pediatrician looked serious... He actually had this guess before, but Chen Jia didn't believe it.

However, even if he couldn't shrug, what does it mean?

He was about to ask a question, but the patient's test report suddenly flashed through his mind.

At this moment, he seemed to have a flash of inspiration, and looked at Xu Qiu suddenly, saying: "Director Xu, is it... because the cranial nerves are compressed?"

Generally, if patients cannot shrug their shoulders, it is easy to determine whether it is a muscle or nerve problem.

For muscles, see if there are abnormalities in the trapezius, levator scapulae, and rhomboid muscles.

As for nerves, the main consideration is the accessory nerve.

The accessory nerve is the eleventh pair of cranial nerves in the human body, which is mainly divided into brain branches and spinal branches.

Among them, the fibers of the brain branch control the pharyngeal muscles.

The spinal root branch controls the sternocleidomastoid muscle and trapezius muscle on the same side, which is closely related to shrugging shoulders.

Wait...

Thinking of this, the pediatrician suddenly felt like he had an epiphany.

If the accessory nerve is affected, causing abnormalities in both the brain branch and the spinal branch, then the patient's symptoms can be explained!

"And vomiting!"

The pediatrician became excited and analyzed to himself: "If there is a problem with the throat muscles, the pharyngeal reflex will be reduced, and the pharyngeal reflex directly controls vomiting... In other words, the vomiting of the child is also caused by the accessory nerve?"

He quickly looked at the patient's CT report.

The report showed that the lesions of the jugular foramen invaded and spread all the way, and it might really affect the accessory nerve!

"Director Xu, it's cholesterol granuloma!" The pediatrician couldn't be more confident at this moment.

Except for this disease, no other disease can cause such a tricky space-occupying disease!

Xu Qiu nodded gently.

His inference was the same.

However, the current assumptions are just guesses based on the existing evidence.

If you want to confirm the diagnosis, you have to go through some trouble.

Xu Qiu thought for a while and said: "Open a cranial MRI, mainly for the mastoid area, focusing on the temporal lobe and surrounding brain tissue."

Chen Jia and the director of pediatrics looked serious at the same time.

The result is already very obvious, and the diagnosis is only one step away, which is no different from a sure thing.

At this moment, the expressions of both of them were a little shocked.

Chen Jia has been with Xu Qiu for so long. From the beginning, she regarded Xu Qiu as a younger brother, and now she calls him "Director Xu". She has long known how superb the latter's skills are.

Therefore, she manages her expression very well.

But the director of pediatrics was really confused.

Although she knew that Xu Qiu was the thigh of the whole hospital, she still felt a little bit broken after seeing Xu Qiu make rounds several times and quickly find out the cause of the disease.

This type of patient is extremely easy to misdiagnose as a common otitis media infection.

Even if the doctor pays attention, it may be diagnosed as "left ear cholesteatoma".

If it were the director of pediatrics in Linyi, he would probably treat it as cholesteatoma, and wait for the patient to be re-examined a few months later, and then he might find out the problem.

But Xu Qiu is different.

He only relied on a few details, such as resistance to dressing and undressing, not vomiting, and especially judged that he could not shrug and had abnormal pharyngeal reflex, and finally discovered this hidden rare disease!

Thinking of this, the pediatrician was a little terrified.

If this patient is sent to the pediatric department, the condition will be delayed for several months, or even half a year...

Treat a serious illness as a minor one, the consequences are disastrous!

"Fortunately, there is Director Xu..." The pediatrician glanced at Xu Qiu, his face full of fear.

Chen Jia tapped the corner of her mouth, feeling quite honored, as if she was the one who completed the diagnosis.

Speaking of which, Director Xu's clinical thinking is really getting more and more meticulous.

In just one afternoon, he conquered a rare disease that might have to be repeatedly hospitalized and discharged several times in other hospitals, and took several years to finally diagnose...

If I marry Director Xu in the future, with his ability to handle details, if he gets along with other young doctors and nurses in the hospital, I won't be able to catch him at all!

Thinking of this, Chen Jia suddenly felt a little angry.

But thinking that Dr. Xu's interest in surgical instruments is countless times stronger than his interest in women, she suddenly felt comforted.

"Director Xu, I'm going to communicate with the family!" Chen Jia was in a good mood and volunteered to leave.

What's going on? Your mood swings... Are you on your period?

Xu Qiu muttered to himself, but didn't care. He then read the literature again.

It's not difficult to diagnose cholesterol granuloma.

But how to treat it is a troublesome matter.

He calmed down and looked at the system panel.

"It seems that there is no ear canal surgery..."

Xu Qiu glanced at it and shook his head.

Signing in, doing tasks, and brushing up on proficiency, over the years, he has accumulated more and more surgeries and is almost omnipotent.

But there is still a long way to go before he can be truly omnipotent.

For example, at present, he does not have a surgery that can deal with cholesterol granuloma.

"There should be no other doctor in the clinic who can do it."

This heavy task still has to fall on his head.

If it were Xu Qiu three or four years ago, he might have asked the director to go all over the country to get help.

But things are different now.

The system does not include the right surgery, but Xu Qiu can still do it!

This is equivalent to setting up a target somewhere.

Xu Qiu does not have a 98K or an eight-fold scope, so he can't hit it at all.

But, he has a nuclear bomb.

If you want to hit a target, why do you have to aim at the ten rings?

Just cover it with a nuclear bomb and it's done!

This is the scene Xu Qiu is facing now.

He does not have a special surgery for cholesterol granuloma.

But his attainments in the entire surgery are so deep that he is familiar with it. As long as a reasonable plan is formulated, even if it is deep in the jugular foramen or temporal lobe, it is not impossible to challenge!

As his thoughts surged, Xu Qiu's eyes kept searching on the computer screen.

He searched for literature and information from all over the world according to keywords such as "cholesterol granuloma", "treatment", and "surgery".

Half an hour later, he turned to the last page, his eyes slightly dim.

It is indeed a rare disease. Even the international clinical medical community cannot find an authoritative treatment plan.

In other words... this case really has to be done alone.

There is not much experience to refer to!

"There are still many problems to be solved..."

Xu Qiu shook his head, took a piece of paper, and listed the difficulties of the operation on it.

"1. How to enter the surgical area without damaging the developing hearing system?

2. How to protect the exposed dura mater, sigmoid sinus and jugular bulb during the operation?

3. How to remove the granuloma?

4. How to prevent the granuloma from recurring again..."