Where is the most complex and mysterious part of the human body? The brain is certainly at the top of the list. To operate in this area is always a challenge for doctors through life and death. However, in recent years, with the use of a series of advanced medical instruments and equipment in the clinic, neurosurgery has made great progress: many doctors previously did not even dare to touch the brainstem region surgery, now more and more to carry out; previously nine dead brain aneurysm, now with a “clip” can bring the patient back to life; previously to open the skull of brain hemorrhage, now only need to open the skull in the local area. Brain hemorrhage that used to be craniotomy can now be completed by inserting a thin tube into the patient’s head under local anesthesia.
Brain stem tumor: even the forbidden area of life can be operated
Eight years ago, 32-year-old Ms. Fang almost lost her life because of a tumor growing in the brainstem area. That year, Ms. Fang was on a business trip to Guilin when she had a severe headache one night and passed out soon after. When she woke up again, she was already in a hospital bed surrounded by her family. The neurosurgeons from several local hospitals in Guangxi concluded that a large tumor had grown in Ms. Fang’s brainstem and that the situation was hopeless, so the family should prepare for the aftermath.
However, Ms. Fang’s mother was not willing to see her daughter die like this, so she brought her daughter to Guangzhou overnight and was sent to Guangzhou First People’s Hospital by ambulance. According to Cao Zhikai, the director of neurosurgery who was in charge of the surgery, the patient’s tumor was a hemangioma, relatively large and growing in the pontocerebral part of the brain stem. When the patient was admitted to the hospital, the tumor had already compressed the brain stem and caused coma.
However, surgery on brainstem is not a joke, as a few milliliters of brainstem bleeding can be fatal, and brainstem tumor was considered a “no-go” area in the past, with deep location, difficult surgery and easy to cause damage to important structures in the brainstem, “If you are not careful, the patient may suffer cardiac arrest, and the chance of successful surgery is only 20%. The chance of success is only 20 percent.” However, the patient’s family’s understanding and cooperation gave the doctors a lot of confidence, “They said any result was acceptable and let us go ahead.”
In the end, Ms. Fang became the lucky 20 percent, and the surgery went very smoothly, as doctors successfully peeled the tumor out of her brain stem without damaging any brain tissue.
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Cao Zhikai told reporters that Ms. Fang’s case was a great inspiration and encouragement to them back then. “She was the first case of surgery in the brainstem region carried out in our hospital, and since then, we have invested a lot of research and practice in this field. Now, eight years later, we have successfully completed more than 30 surgeries in the brainstem region, with a success rate of more than 90 percent.”
According to Cao Zhikai, the reason why neurosurgeons are now able to successfully traverse the “forbidden zone” of surgery is not only the skill of the doctors themselves, but also depends on the advancement of various surgical instruments and equipment. Nowadays, before a patient undergoes surgery in the brainstem region, a special magnetic resonance examination is conducted to present the tumor location, the relationship between neurofibrillary and tumor and other parameters through imaging technology, so that doctors can make adequate preoperative preparations. The increasingly advanced electron microscopy technology, on the other hand, helps to expand the surgeon’s vision during the operation and allows the operation to be done more delicately. In addition, comprehensive intraoperative electrophysiological monitoring allows for early warning of any changes during surgery, allowing the surgeon to make the appropriate treatment in a timely manner.
Brain aneurysm: a small opening in the eyebrow can be operated on
Mr. Zhao, 62 years old, suddenly fainted at home a few days ago and was taken to the hospital by ambulance. After imaging, Mr. Zhao’s cerebral artery grew a hemangioma. Due to the impact of blood, the tumor swelled up in the blood vessel like a “balloon” and once it ruptured, it would cause extensive cerebral hemorrhage and the patient’s life was in danger. According to Cao Zhikai, the mortality rate of a ruptured cerebral aneurysm is as high as 30%, so how to plug the gap in the blood vessel before it breaks is the key to treatment.
In the past, a case like Mr. Zhao had to open an opening of more than 10 centimeters in the forehead. Now, with the development of a procedure called “aneurysm clamping”, the situation has changed dramatically. The doctor simply makes a small incision of about 4 cm near the patient’s brow bone, enters the patient’s brain from there, finds the location of the aneurysm with the aid of microscopic technology, and then clamps the “neck” of the aneurysm with a special “clip” to prevent blood from passing through the weak part of the aneurysm again. A special “clip” is then used to hold the “neck” of the aneurysm to prevent blood from bleeding through the weak part of the aneurysm again, while restoring blood flow to the vessel.
In addition to surgery, there is an interventional approach to brain aneurysms. This method is mainly used for multiple aneurysms, where there is more than one aneurysm in the patient’s head and it is difficult to perform the surgery through open surgery. A guide wire is used to enter the body through the femoral artery at the base of the thigh and cross the carotid artery to find the “nest” of the aneurysm. After the spring enters the aneurysm, the doctor presses the “launcher” outside the patient’s body, and the spring curls and fills the aneurysm, which becomes solid, so that blood cannot break through the “balloon”.
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Both surgical and interventional methods have their own advantages and disadvantages and indications, and sometimes they cannot be substituted for each other, both of them are elaborate “sculptures” on weak blood vessels, and the slightest carelessness can ruin all the work. The patient’s prognosis also depends on the severity of the bleeding, the degree of brain damage after aneurysm rupture and the recovery of the patient’s intracranial condition after surgery.
Cerebral hemorrhage.
Minimally invasive surgical drainage instead of craniotomy
This year, 51-year-old Zhang is a driver for an organization. A few nights ago, he met with friends to eat hot pot, and after a few glasses of white wine, he suddenly had a splitting headache, and then passed out in the restaurant on the spot. After he was taken to the hospital, the situation was urgent, and the doctor immediately performed “minimally invasive square body directional drilling cranial hose hematoma suction”, and the patient began to regain consciousness the day after the operation, and basically resumed life and work two weeks later.
Cao Zhikai said that in the past, this type of brain hemorrhage often required craniotomy. But since the hospital began to carry out micro-innovation technology in 2004, craniotomy has gradually become a “thing of the past”, “except for cases with particularly large bleeding areas and serious conditions.” The new method involves making a small hole in the patient’s head, finding the bleeding site under bedside CT monitoring, and inserting a small catheter to drain the hematoma out of the body. It is understood that the hospital has successfully cured more than 500 cases of hypertensive cerebral hemorrhage patients through this type of surgery.
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Compared with traditional craniotomy, this treatment has the advantages of no general anesthesia, intubation, craniotomy and blood transfusion, and can be performed at the bedside and under CT monitoring, etc. Patients have a shorter hospital stay, faster recovery, and lower costs, often one-fifth the cost of traditional craniotomy or conservative treatment.
In the past, the mortality rate of non-surgical treatment was 40% to 70%. In the past 10 years, with the development and popularization of minimally invasive surgical treatment, the efficacy has been improved and the mortality rate has been significantly reduced to 3% to 33%. Experts analyze that seasonal changes as well as changes in external temperature can affect the normal metabolism of human neuroendocrine, change blood viscosity, plasma fibrin and epinephrine are elevated, capillary spasmodic contraction and increased brittleness. “A short time intracranial blood vessels can not adapt to such a more pronounced change, that is, there are fluctuations in blood pressure, if coupled with some external triggers, such as fatigue, emotional excitement, alcohol, etc., it is easy to lead to the occurrence of cerebral hemorrhage.”