Therefore, the smoothness of the doctor's operation is required. Do not poke the wrong place or bleed casually, which will become a medical accident.
Doctors must keep the whole process smooth without any obstacles, and go straight to the target lesion without getting lost. They must first find out the way to go, just like driving a car. How to take this surgical approach, for example, there are routine practices for other types of surgery (if you have a car map navigation when driving), you have colleagues and your own surgical experience to accumulate (other drivers have taught experience or you have driven it yourself)
The experience of this road is used as a base).
There are two conventional positions for the transnasal sphenoidal approach, one is the supine position and the other is the semi-sitting position.
Just by looking at the position of the latter patient, we know that the supine position of the former patient is definitely not a horizontal supine position, but only a supine position with the head high and the feet low.
This is determined by human anatomy. The anatomical path of the transnasal sphenoidal approach has been mentioned earlier. The transnasal cavity enters the brain through the special anatomical opening of the sphenoid sinus.
Comparison of gastroscopy and colonoscopy.
The gastroscope colonoscope is a doctor's tool like a snake walking around in a tunnel. There is an advantage to walking through the tunnel. If you go wrong, you will retreat and advance, as long as you don't hit a wall, there is no high risk. Nasal sphenoid surgery is not. After passing through the sphenoid sinus, the surgical instrument is directly inserted into a ball of "tofu". Since it does not go through the tunnel, it needs to be pushed back and the "tofu ball" is opened again, which is very easy to accidentally injure the surrounding area. The "tofu
brain".
However, these adjacent "tofu brains" that are easy to accidentally injure are particularly important in anatomy, so the sequelae of the operation are particularly terrible.
If the position is wrong, if you run down, you will hit the brain stem, and if you are not careful, you can directly kill the brain stem.
Moved to a higher point, the optic nerve was damaged and the patient was blinded.
If it deviates from the midline and punctures the cavernous sinus and internal carotid artery, hemorrhage during the operation will undoubtedly lead to death.
In order to avoid these horrible incidents, the best way is for the doctor to reach the lesion in one step without further exploration after entering the "tofu brain".
To achieve this, the doctor needs to find out the entry angle of the sphenoid sinus opening, and accurately operate the "tofu brain", both of which are indispensable.
Previously, doctors can calculate angles based on imaging films, such as neural three-dimensional navigation software.
To do it later, it is too difficult for the doctor to use tools to adjust the angle. If it is difficult to understand, it can be compared to brushing a long-handled cup at home with a strange-shaped cup with a narrow mouth and a long mouth. If you want to clean the stubborn stains on the bottom of the cup, but the brush can't reach it, do you actually have to figure it out early in the morning
It is best to adjust the angle of the cup so that the cup brush can easily reach the bottom. Adjusting the angle of the cup is equivalent to adjusting the patient's head position in neurosurgery. Therefore, the above-mentioned transsphenoidal surgery inevitably has the head high and the feet low. Exactly how high the head position is depends on the doctor
Calculated in the previous step.
Not all doctors can calculate it accurately, and more clinicians use a large number of clinical mice to practice and sacrifice to accumulate experience.
A doctor with a particularly high IQ can be counted without a mouse. It's a pity that doctors who can achieve this perfect goal are rare.
"Only one operation position?"
(Is there only one surgical position?)
Dr. Charlie raised a finger to Dr. Tong to check whether it was really a position for the whole operation. As mentioned above, it is difficult for a good doctor to determine the entrance angle of the sphenoid sinus for the transsphenoidal approach. The determination of the approach of transcranial surgery, as mentioned in the previous surgical examples, is also very difficult.