I am a kryptonian doctor

"Well, I performed an operation on a huge intracranial aneurysm in the emergency room, and it was very successful. So I believe I can also perform your surgery."Yang Tian said eagerly.

He has never done this kind of surgery before, but he got this huge intracranial aneurysm surgery skill in the lottery a long time ago, and it is still a master level!

So no matter how difficult it is, for huge intracranial aneurysm surgery skills Aneurysm surgery, he thinks he can do it

"ah? Did you actually do this kind of surgery over there in the surgical emergency room?"Qian Sen said dubiously. For example, patients with intracranial hemorrhage sometimes have their families sent to the emergency room without knowing it.

So when some sudden patients come to the emergency room, Director Yang Jinrong there can also provide emergency treatment.

After all, The director of the surgical emergency department is definitely the most knowledgeable in surgery!

"I don't need to lie to you. Although this kind of surgery is difficult, I think I can learn well. If you don’t believe it, you can refer to my pancreaticoduodenectomy. Also, if anything goes wrong with this surgery, I will be responsible for it. Yang Tian said with a faint smile.

"Forehead……"Qian Sen was speechless for a moment. Because of Yang Tian's pancreaticoduodenal surgery, the whole hospital knew that Professor Anderson was not that strong!

"Okay, let's do the surgery now, the patient can't delay."Qian Sen still made a decision, let Yang Tian perform this operation! He can't control so much now. And there is the guarantee sworn by the other party that if anything goes wrong, he will be responsible to the end.

If you dare to say such things, you must usually have something in your hand. Otherwise , you don’t have to take such risks. Will your salary increase if you do more surgery?

No, it will increase the risk and pressure on yourself!

If a patient has a problem, you are asking for trouble.

Therefore, doctors will definitely not do it if they don't have the ability.

Qian Sen subconsciously felt that Yang Tian was taking care of him. Maybe this kind of operation had been done and it was successful, otherwise he wouldn't have dared to come forward!

Soon, Yang Tian followed the two doctors Qian Sen to the operating room, and the operation started immediately, and Qian Sen performed it himself. artery(MCA)Bifurcation aneurysms account for approximately 35% of cases. Because of their location, lateral orientation, and close proximity of the aneurysm roof to lobar tissue, nearly 50% of cleavage MCA aneurysms contain intrasurface hematomas, with the majority of hematomas (80%) located in the temporal lobes.

MCA aneurysms most commonly occur at the bifurcation, but can also occur in the proximal M1 segment or the distal M3 or M4 segment. Differences in location affect the surgical approach and location; however, the anatomical and morphological characteristics of MCA aneurysms make surgical clipping the preferred treatment for most patients.

Yang Tian looked at the CTA examination information and paid special attention to whether the MCA had a trifurcated structure.

"It is an M2 bifurcation structure, and preoperative angiography can begin!

"Yang Tian glanced at the patient's examination report briefly and indicated that preoperative angiography could be performed.

Preoperative cerebral angiography is necessary.

It can clarify the shape of the aneurysm neck, the location of the arterial trunk behind the giant aneurysm sac, and the superficial temporal Whether the artery is suitable for vascular reconstruction, etc.

The contralateral blood flow situation needs to be evaluated.

It is not uncommon for the M2 bifurcation outlet to be stenotic.

If clipping is used, the surgery must leave enough lumen for the M2 segment of the vessel to prevent the posterior part of the M2 from approaching.

Bifurcation stenosis.

The presence of calcified plaque across the aneurysm neck or aneurysm dome suggests the need for vascular reconstruction. Mild calcification of the aneurysm dome on imaging is usually associated with occult microcalcification of the aneurysm neck relative to the location of the intracystic thrombus. The location of the cavity is more important.

The presence of atherosclerotic vessels means that the contralateral blood supply is poor, and even if a moderate occlusion time (10-15 minutes) is selected within the acceptable range of burst suppression, the risk of cerebral infarction is still high. In this case, pre-bypass should be considered.

At this moment, Yang Tian's mind flashed through the surgical experience, key points and difficulties of huge intracranial aneurysm surgery, and what would happen.

Soon, after the angiography was completed, Yang Tian took a look. The situation of the patient's intracranial arteries was immediately known in my mind. It was a huge MCA aneurysm (proximal segment of M2) with partial thrombosis, accompanied by calcified plaque formation on the aneurysm wall. Preliminary vascular reconstruction of the main trunk and distal branches, after bifurcation. , proximal occlusion leading to intra-aneurysmal thrombosis

"Start the craniotomy!"Yang Tian opened his mouth.

Faced with this huge aneurysm in the cavernous sinus segment, Yang Tian adopted a pterional approach and removed the anterior clinoid process through the epidural or subdural mater. The scalp incision was slightly expanded toward the temporal part. Yang Tian's craniotomy The common carotid artery and internal and external carotid arteries in the neck were quickly exposed to everyone's eyes.

Then, Yang Tian began intradural treatment.

Qian Sen and others watched Yang Tian's two dexterous hands flying up and down. I looked at it for a while and was stunned.

"This speed... Are you sure you can achieve this level of proficiency after only one or two surgeries?"Qian Sen was shocked. He saw Yang Tian's intradural treatment at this moment. This speed, this without any mistakes, this novel surgical method, he felt as if the other party had done thousands of such surgeries. The same illusion.

During the entire intradural dissection operation, the use of fixed retractors is often avoided because the retractor blades often block the operating angle and can cause brain damage. However, fine adjustment of the permanent aneurysm clip is required. In the final stage, a fixed retractor will be used as a"third hand" for temporary retraction, and a suction device will be used to adjust the aneurysm neck and body.

But if you look at Yang Tian, you can see that he does not need a fixed retractor at all. Using only two hands, he used speed and other unique skills to complete the pulling in just 2 seconds!

"Can this surgery still be performed like this?"Qian Sen was completely impressed by Yang Tian in his heart! He is indeed a genius in the surgical emergency room, and he can actually develop a new surgical method.

At the same time, the other party's surgical skills and speed are too terrifying!

Just in Qian Sen For a moment, he saw Yang Tian starting to separate the aneurysm!

Qian Sen took a breath and told himself not to be distracted. He must watch this extremely high-level intracranial aneurysm surgery. This was very important to him. He said that this was a textbook-level operation! He felt that even the director of his department could not do it.

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