crazy scalpel

Neuronal hamartoma!

In fact, this is not a real tumor, but the nerve tissue grows in the wrong place, and usually grows very slowly, that is, the tumor will not grow bigger and bigger like the kind of tumor caused by cell mutation.If it is only precocious puberty, it can be controlled by suppressing hormone drugs.

But in addition to precocious puberty, this little girl also affected other brain cell groups, resulting in abnormal electrical discharges and brain dysfunction, that is, epileptic seizures.In this case, surgical treatment is required.

However, no matter how excellent the technique of the person performing the operation is, the damage caused by the operation will be considerable.Xie Ke looked at the girl's finished film, and the black spot deep in the brain was the object that needed to be surgically removed.However, because the location is too central, no matter whether you choose the pterional approach or the transcallosal anterior interfornix approach, there is no guarantee that other tissues will not be cut while resecting the hamartoma.

However, the brain is the most important part of a person's body. It is not an exaggeration to say that it is the headquarters or the CPU.Any damage to the brain, even a small one, will have serious consequences when reflected on the body.Xie Ke can make a smaller bone window than others, cut off fewer bone flaps than others, and stop more blood than others, but he cannot operate deep in the brain without damaging the brain tissue.

If other doctors knew that Xie Ke thought so, they would definitely laugh at his unfounded worry.Brain surgery, how can you look forward and backward like this?This is the department closest to the god of death. Brain surgery has always been to rescue patients from the minions of the god of death. As for what happens after they are rescued, this is not the primary consideration.

Brain surgery is so dangerous, if the patient is an octogenarian, as long as it does not endanger his life, Xie Ke will definitely persuade him to give up the operation and enjoy life instead.But now the patient is a little girl. If the hamartoma cannot be removed, her condition may get worse and she will spend her whole life in regret.This is not just a problem caused by sexual physiology, but the seizures prove that the location of the hamartoma can cause abnormal brain function, so there may be problems such as mental decline and memory loss in the future.

The mother and daughter also saw the small black dot on the CT scan. They didn't know the characteristics of the neuronal hamartoma, they thought it was a real tumor, and they were ready for surgery.Seeing that Xie Ke was in deep thought, the mother thought that he was afraid that she would not be able to bear the expenses, so she said weakly: "Doctor, as long as it is for the baby's treatment, no matter how much money it is, even if it is to borrow, I will definitely chip it in." of."

Seeing her like this, Xie Ke knew that she had misunderstood, so he explained the difference between the girl's condition and medical treatment and surgical treatment.

After listening to the mother, she realized that the so-called drug treatment can adjust human hormones, not the treatment of the lesion itself, and it is difficult to improve the seizures of epilepsy.She also knows what it means to a girl.Her daughter's grades have slipped a little recently. Now it's only elementary school, and the exams are just writing words and adding, subtracting, multiplying and dividing. Have a great marriage...

However, the surgery was said to be so scary by the doctor, so she didn't dare to gamble.On the one hand, if the operation is not performed, it is certain that life in the future will be very difficult. On the other hand, if the operation is performed, it may be cured, but it may be more miserable than not having the operation.No matter how courageous a mother Ren is, it is difficult for her to make such a choice for her children.

Seeing her in a dilemma, Xie Ke couldn't bear it, thinking that it would be great if his scalpel could directly remove the hamartoma without harming other brain tissues.

and many more!

Xie Ke's eyes lit up, and he thought of a feasible method!

Rays!

The knife at Xie Ke's own fingertips is definitely useless, even though he had already used its illusory form to cut into the girl's brain just now, pointing at that small tissue.But this can only be seen by himself, and the fingertip knife can't cut it in the illusory state, at most it can make Xie Ke feel where it passed.

This is of no use to Xie Ke, as if he has the structure of sensing three-dimensional objects.And these can also be obtained through computer and image shooting.At most, he has a more vivid and in-depth understanding of spatial location than others.

But because of this three-dimensional positioning, Xie Ke thought of a new emerging technology, that is-stereotactic radiation therapy.

Stereotaxic, as the name suggests, is to fix the depth helmet on the frame, measure the distance from dozens of specific points on the cranial surface to the center, simulate the three-dimensional image of the skull, and then display it on the three-dimensional coordinates.As for radiation therapy, besides the x-knife, there is also a gamma knife.Gamma Knife uses cobalt as the radiation source. After being corrected by the collimator, it can form a beam of high-energy rays focused on the center of the hemisphere, and focus the rays on the lesion at one time, so that the tissue outside the lesion target can be healed due to the sharp reduction of radiation. Avoid damage.

It was the best form of therapy for this little girl!

But it is easier said than done. The cost of gamma knife related equipment is very high. Only the First Affiliated Hospital of Jiefang University in Tianhai City is equipped with this treatment system.I also know that the cost of treatment is quite high.

This is not the biggest problem, after all, the family members of the patients have indicated that they are willing to pay no matter how much money they have.The biggest problem with stereotaxic difficulty is precision.If the accuracy cannot pass the test, no matter how advanced the equipment is, it will be nothing.

The accuracy of Gamma Knife depends on the processing of image data and reliable mechanical precision.

In terms of output dose, the repeatability, continuity, accuracy and switch state of the timer, as well as the total dose and the output dose of various collimators need to be regularly determined.In terms of mechanical precision, the stereotaxic instrument and its adapter, the coincidence of the mechanical ray center, the cobalt radioactive decay coefficient, the distribution shape of the 201 beams of rays after convergence, and the fastening of the sliding treatment table and the helmet, etc., also need to be fixed regularly. Only by testing can the mechanical precision be ensured.

Then the problem comes, the accuracy of the dose output can be adjusted before the operation, but the precision of the machine needs long-term maintenance.

Xie Ke still knows the situation of the First Affiliated Hospital very well. This set of things has been imported for several years, but it is just for good-looking display. This is also the identity certificate of the best hospital in Tianhai.But it can be said that it may not be used ten times a year to treat patients.

Such infrequently used machinery and equipment, not to mention the maintenance and regular inspections, but the people who use them are also very problematic.Because it is rarely used, the user must be inexperienced.The cost of using it once is tens of thousands or hundreds of thousands. How can the hospital give doctors the opportunity to "practice"?

As a result, the accuracy of the Gamma Knife cannot be guaranteed, either from a mechanical point of view or from a human point of view.The highest pursuit of brain surgery is precision. Only precision can avoid injury, and prevent people after surgery from living worse than death.

In brain surgery, doctors have always believed that they would rather cut less lesions, and try to keep the good parts as much as possible.If a tumor is connected with a piece of brain tissue, and there is no way to completely separate it from your perspective, then it is better to leave a little tumor tissue there.Successful surgery does not lie in total or clean resection, but in postoperative recovery!

If the Gamma Knife is not precise enough, and the error and offset of the target point cause damage to the place that should not be damaged by the ray, then the meaning of stereotactic radiosurgery will be completely lost!This is probably one of the reasons why this treatment method has not been popularized in China so far.

However, the precision control that others cannot achieve does not mean that Xie Ke cannot do it.Xie Ke's phantom finger knife can reach the lesion with precision.This is something no one else can do, or even imagine.

"Besides drug therapy and craniotomy, there is another method." Xie Ke pursed his lips, and said to the mother and daughter: "It is radiation therapy. But this kind of technology and equipment is currently not available in the radiology department of our hospital." Yes. Tianhai City is only available in the First Affiliated Hospital of Jiefang University. You have to go there. However, even the doctors there have very limited mastery of this technology. I suggest you go there for hospitalization and surgery, but choose us The neurosurgery director of the hospital, Dr. Cai Tianqiao Cai, is the chief surgeon. Because he came back from the United States, he is quite experienced in this kind of operation. Don’t worry, I will help you get through the relationship, but the treatment cost is estimated to be difficult to avoid. You still have to prepare yourself."

Xie Ke pushed Cai Tianqiao out for a reason. Although he didn't know whether Cai Tianqiao was really experienced in this kind of surgery, Cai Tianqiao's name back from the United States was not fake, and he was still very capable of bluffing people.

His purpose is threefold.

First, the doctors at the First Affiliated Hospital of Jiefang University would not find it strange that Cai Tianqiao performed the operation.Xie Ke himself graduated from Jiefang University, and he spent his internship in the Neurosurgery Department of the First Affiliated Hospital.It can be said that the medical staff there knew no less about him than the one in the city's No. [-] Hospital.He has never done this kind of radiosurgery before, and his research direction has nothing to do with it. It would be too strange if he suddenly recommended himself that he could do it, and no one would believe it.Cai Tianqiao is different, he came back from a more developed area, no matter what he is, at least others will have a higher degree of trust in him.

Second, the family members of patients are more acceptable.Don't look at how convinced this mother is of Xie Ke now, once she knows that Xie Ke wants to be the chief surgeon of her daughter, it is conceivable that she will immediately shake her head and refuse.Are you kidding, how can you be so young?Even if she knew about Xie Ke's deeds that were spread on the Internet, those were anatomy after all, and it was another matter in a new field of radiation.Besides, a person's energy is limited, Xie Ke is so good in anatomy, it is inevitable that people think that he may be flawed in other aspects.But if it is Cai Tianqiao, no matter it is fame, qualifications and professional title level, it will be a lot of reassuring.

Third, Xie Ke must come on stage as an assistant.In any case, Shayk's purpose is for him to control the precision.If the operation was handed over to others, no one would listen to him.The only ones who can be completely trusted, Xie Ke thinks about it, are Professor Xu and Cai Tianqiao.Professor Xu knows Xie Ke too well, but his relationship with Cai Tianqiao has always been cloudy, as if separated by a layer of veil.Perhaps Cai Tianqiao would guess in his heart or find a way to spy on Xie Ke's details, but Xie Ke was sure that he would cooperate.This kind of tacit understanding is not very clear, it is just a feeling.

In addition, about the last seminar, Xie Ke thought about it, and always felt that Cai Tianqiao didn't know what role he played in it, but there must be one!ask!question!

Among other things, if you use yourself to exchange for Professor Nat's speech, you will definitely not be able to escape.

Hmph, since you use me, then I will use you too, everyone is even.

Brother said, you can eat anything, but you can't lose.