Therefore, doctors are required to ensure the smoothness of the operation process and not to accidentally poke the wrong place or cause bleeding, otherwise it will become a medical accident.
To keep the whole process smooth and without obstacles, and to reach the target lesion without getting lost, the doctor must first know the way to go, just like driving a car.
How to take this surgical approach, like other types of surgeries have conventional practices (if you use a car map to navigate when driving), you have the experience of colleagues and yourself to accumulate (other drivers teach you experience or you have driven this road yourself)
experience as a basis).
There are two conventional positions for the transnasal transsphenoidal approach, one is the supine position and the other is the semi-sitting position.
Just by looking at the patient's position in the latter, you will know that the patient's supine position in the former cannot be a horizontal supine position, but can only be a supine position with the head high and the feet low.
This is determined by human anatomy. The anatomical path of the transnasosphenoidal approach has been discussed before, and it enters the brain through the nasal cavity and through the special anatomical opening of the sphenoid sinus.
Compare gastroscopy and colonoscopy.
Gastroscopy and colonoscopy are tools for doctors, just like a snake walking back and forth in a tunnel. There is an advantage to walking in a tunnel. If you go wrong, step back and step forward. As long as you don't hit the wall, there is no high risk.
Rhinosphenoidal surgery is not like this. After passing through the sphenoid sinus, the surgical instruments are directly inserted into a ball of "tofu". Since there is no tunnel, the "tofu ball" needs to be moved back and forward again. It is very easy to accidentally injure the surrounding areas.
"Tofu brain".
However, these adjacent "tofu brains" that are easily injured by accident are particularly important in anatomy, so the sequelae of surgery are particularly terrible.
If the position is wrong, if you run down and hit the brainstem, you may die directly from the brainstem if you are not careful.
When it was moved higher, it hit the optic nerve and caused blindness to the patient.
If it deviates from the midline and pierces the cavernous sinus and internal carotid artery, severe bleeding during the operation will inevitably lead to death.
In order to avoid these horrific incidents from happening, the best way is for doctors to reach the lesion in one step without having to explore again after entering the "tofu brain".
To achieve this, the doctor needs to find the correct entrance angle of the sphenoid sinus and accurately operate the "tofu brain", both of which are indispensable.
Previously, doctors could use neural 3D navigation software to calculate the angle based on imaging films.
To do it later, it is too difficult to just let the doctor use tools to adjust the angle.
If it’s difficult to understand, it can be compared to using a long-handled cup at home to brush a weird-shaped cup with a narrow mouth. If you want to clean the stubborn stains at the bottom of the cup, but the brush can’t reach it, do you actually have to plan and adjust the cup early in the morning?
The angle makes it easy for the cup brush to reach all the way through.
Adjusting the angle of the cup in neurosurgery is equivalent to adjusting the patient's head position. Therefore, the transnasal sphenoidal surgery mentioned above has the inevitable head-high and low-foot position. How high this head-high position is will test the doctor's previous step.
calculated.
Not all doctors can calculate it accurately, and more clinicians use a large number of clinical mice to practice and make sacrifices to accumulate experience points.
Doctors with particularly high IQs don't need a guinea pig to calculate. Unfortunately, doctors who can achieve this perfect goal are rare.
"only one operation position?"
(Is there only one surgical position?)
Dr. Charlie raised his finger to Dr. Tong to verify whether it was really the same position throughout the surgery.
As mentioned above, it is difficult for a good doctor to determine the entrance angle of the sphenoid sinus for the transnasal sphenoidal approach. The determination of the transcranial surgical approach has been described in many surgical examples before, and it is equally difficult.