Start with an emergency physician
Chapter 99
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Seeing Wei Lili's face was not good, Zhou Yuan's expression became serious and he looked at the examination results.
The MRI image showed that the brain tissues of the two conjoined twins did not fuse and share. In other words, as long as the separation is appropriate, the two children can develop like normal children.
This is a relatively good situation. Some conjoined twins even share a brain and cannot be separated at all. Some have two brains but part of the brain is defective. If they are to be separated, only one can keep a relatively complete brain and the other one will have a defective brain.
Fortunately, it is not the latter, otherwise, this choice is too cruel for parents.
There is nothing wrong with the MRI image, which is good news, but the other cerebral angiography is not so optimistic.
It can be seen that the cerebral arteries and veins of the conjoined twins have cross-supply of blood. Although some blood vessels are each of them, they are bonded together to form double-lumen parallel blood vessels.
Some blood vessels may even have cavity fusion.
In other words, once separated, the parallel bonded blood vessels will split, which may cause blood vessel rupture.
Obviously, the two results show that this pair of conjoined twins is a type of conjoined twin that is more difficult to separate.
""Has the 3D printed model come out yet?" Zhou Yuan asked.
He needed to determine the condition of the superior sagittal sinus in the conjoined twins' brains.
Once the superior sagittal sinus fused, it would be more difficult to separate the conjoined twins.
"The scan is finished and printing is in progress." He Jing said.
Zhou Yuan nodded, looked at the conjoined twins sleeping in the ward, and asked,"How are their physical conditions now?"
Wei Lili said,"Don't worry, the neonatal ICU students, specialist nurses, etc. are taking good care of them and paying close attention to their physical changes. There will be no problems."
He Jing said,"We are also gradually improving the patient's preoperative preparations." Zhou Yuan breathed a sigh of relief, nodded, and looked at Xiao Xuebao, the director of neurosurgery, who was staring at the MRI image next to him:"Director Xiao, what do you think?"
Xiao Xuebao touched his chin, frowned, and asked back,"What do you think?"
"Although the conjoined twins had crossed blood vessels shortly after birth, their brains were intact and could be separated. The earlier the separation surgery is performed, the better it will be for both of them. If it is delayed, their brains may grow together, and it will be almost impossible to separate them at that time."
If the brains are really glued together, any movement of the knife may damage the functional areas of the brain and cause lifelong trauma. At that time, separation will be impossible.
Zhou Yuan continued:"Perform the separation surgery as soon as possible while they have not grown together yet."
Xiao Xuebao nodded:"I think it should be done as soon as possible!"
Zhou Yuan:...
The patient's father looked at Zhou Yuan uncertainly:"Yes...you will do it?"
"Our entire team will be involved." Zhou Yuan said truthfully.
"You are so young and you are also participating in the operation?!" The patient's father stared at him, not feeling reassured.
"I was the lead surgeon."
This kind of thing cannot be concealed, and it should not be concealed.
The patient's parents immediately widened their eyes.
"I don't think you are a good doctor! You just graduated from school, right? If you perform the surgery, can our child be saved?!"The patient's father was a little angry.
He felt that the hospital was perfunctory.
Zhou Yuan patiently explained:"We have a whole team. Doctors from neurosurgery, plastic surgery, brain surgery, etc. will be involved, and there will be many directors."
"We will choose the most suitable surgical method for your child, and we will also choose the most suitable doctor!" Wei Lili said.
The father of the conjoined twins wanted to say something, but was stopped by his wife.
"I believe in your hospital.……"The mother of the conjoined twins took a look at the children in the ward and her voice gradually became quieter.
"Let's go and have a look at the 3D printed model first." Zhou Yuan said helplessly.
He Jing and Wei Lili stayed for the time being, preparing to explain clearly to the patient's family, while Zhou Yuan, Xiao Xuebao and Lu Chenxi prepared to proceed with the next plan.
In the end, the thing that Zhou Yuan was most worried about happened - the 3D printed model clearly showed the fusion and sharing of the superior sagittal sinus of the conjoined twins.
This is a structure located in the sagittal sinus groove between the upper edge of the falx cerebri and the midline of the inner plate of the skull. It is a single dural venous sinus, which collects blood from the superior cerebral meridians, dural veins and cranial veins, and is particularly important.
At the same time, it also contains cerebrospinal fluid, and there are 10 to 15 superior cerebral meridians connected here. Once the structure here is damaged, it will cause paralysis or even death.
Therefore, it is very difficult to separate the superior sagittal sinus of conjoined twins.
"I can't do it." Xiao Xuebao took a look and shook his head, admitting that he was incapable.
"When performing skull separation, we will cut here. How to do it?"He sighed and looked at Zhou Yuan. Zhou Yuan thought for a while and said,"Cut the middle and posterior third of the superior sagittal sinus, and then perform repair surgery."
"Yes, it is possible, but the blood vessels are too dense and if you don't control it well,……"
"I'll do it." Zhou Yuan said coldly.
Xiao Xuebao was stunned and nodded.
Soon, doctors from neurosurgery and plastic surgery also arrived.
Together with pediatricians, Wei Lili, He Jing, Lu Chenxi, nurses, anesthesiologists and others, the team has reached fifteen people.
In just three days, the team held five or six meetings to discuss the specific plan and steps of the operation.
Finally, Zhou Yuan finalized the final surgical plan, which can be summarized as four steps:
First: perform strip skull resection.
This step mainly involves removing part of the skull at the fusion site of the conjoined twins.
Second: perform soft tissue resection.
It is mainly to insert a soft tissue expander under the skin to relax and expand the fused skin to ensure that the head has more skin area after separation. This will make it easier to suture the skin after separation.
Third: separation of the cerebral hemispheres.
With the help of computer navigation technology, the two cerebral hemispheres of the conjoined twins are separated separately.
The last and most difficult step: separation of the shared sagittal sinus.
Not only is it extremely difficult for Zhou Yuan's team, it is also an extremely difficult decision for the parents.
Because... separation of the shared sagittal sinus means that it is very difficult to handle, and you can only choose one baby to get more and one baby to get less, and the one with less will inevitably be developmentally delayed.
Zhou Yuan is a doctor and cannot make this decision.
Soon, the parents of the conjoined twins were invited over.
Zhou Yuan and others introduced the entire surgical process to them, and finally asked in a deep voice:"Now, how do you plan to distribute the upper sagittal sinus?"_
Feilu reminds you: Three things to do when reading-collect, recommend, and divide
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