Chapter 1634: Chapter 1634

Capítulo 1634: Chapter 1193: Why Is the Heartbeat So Slow

Zhang Lin and Little Five, along with several doctors from the institute, came back quite happy. Perhaps everyone expressed their opinions today, and the diagnosis or treatment of the case was greatly aided. Self-confidence can sometimes create a positive feedback loop with tremendous effects.

Song Zimo, Xu Zhiliang, and Xia Shu were still standing on the operating table. Yang Ping checked the time and thought that, given the usual speed of surgery, they should have finished by now. Why haven’t they come down yet? Did they encounter any difficulties in surgery? Although they can each hold their own, in Yang Ping’s eyes, they all still have room for improvement. Improvement has no end.

Yang Ping decided to go to the operating room to take a look. Arriving at the operating room, he changed into scrubs as the room was bustling with activity.

Seeing the instrumental nurse and patrolling nurse at the operation table, Yang Ping remembered Xiao Su. He was deeply moved; Xiao Su had given up her cherished job to silently support him behind the scenes. In his heart, he resolved to treat her well in the future and make her life happy, making sure not to do anything that could wrong her.

The head nurse of the operating room at the institute is Zhou Can, and many new nurses have already been recruited. At Sanbo Hospital, not only do doctors have the opportunity for overseas study, but nurses also have such opportunities and can be sent in groups to top hospitals worldwide for learning. This way, they can keep in step with international standards.

The anesthesia department director is Liang Fatty. Besides Doctor Wei, who was recruited earlier, several young doctors have been added. This is to cope with the institute’s increasing number of surgeries. In fact, the institute is very restrained, trying to control the number of inpatients and only taking on high-difficulty, high-risk complex cases. If there were no set standards to limit case intake, the institute could potentially expand into the world’s largest hospital, with bed capacity increasing to tens of thousands, which wouldn’t be difficult.

But that would be pointless. Whether it’s the institute or Sanbo Hospital, what they pursue is a high-tech route, which precludes arbitrary expansion.

“Any difficulties?” Yang Ping asked.

“A right-side brainstem cavernous hemangioma with bleeding, but this blood vessel has issues. It’s very fragile and hard to separate.” Song Zimo was working on separating the cavernous hemangioma. He was relatively calm, not panicking when encountering such a problem, perhaps because he felt he could handle it, so he didn’t call for Yang Ping.

Yang Ping stood at the film viewer, examining it carefully. “Wasn’t this considered before surgery?”

“From the MRI images before surgery, we could see that the vessel wall was not quite normal, and these issues were taken into account, but the estimation was still insufficient. I didn’t expect in surgery it would be so tricky, and it’s easy to tear if not careful. The abnormal blood vessel also adheres to the surroundings, making separation quite difficult.” Song Zimo paused his operation for a short rest, using the break to explain the situation to Yang Ping.

The brainstem is composed of three parts from bottom to top: the medulla oblongata, pons, and midbrain.

The pons, part of the brainstem, is located between the medulla oblongata and midbrain, with transverse grooves marking its anterior and posterior borders. The ventral surface of the pons is the pontine base, which contains many transverse fibers connecting the cerebellar hemispheres. Besides the transverse fibers, there are also some longitudinal nerve fibers.

There are many cranial nerves entering and exiting the pons: trigeminal nerve, abducens nerve, facial nerve, and vestibulocochlear nerve, which control most of the sensory and motor functions of the human body, particularly including the regulation center related to breathing.

Due to the special location of the brainstem, any surgery occurring in this area must be a high-level, high-difficulty surgery.

Cavernous hemangiomas are not true tumors but a type of vascular malformation. These vascular malformations can occur in other areas, such as the skin, or intracranially.

The occurrence rate of cerebral vascular malformations in the population is relatively low, about 0.1%-4.0%, with four basic types: developmental venous anomaly, capillary telangiectasia, cavernous vascular malformation, and arteriovenous malformation. In fact, they are all benign. Developmental venous anomalies and capillary telangiectasias typically have less impact, while cavernous vascular malformations and arteriovenous malformations are more likely to lead to neurological sequelae.

The brain is the most common site for cavernous hemangiomas, with a high incidence rate of 70%-90%. According to literature reports, cases have occurred throughout the supratentorial region, but most commonly in the subcortical region, prone to appear in the rolandic area and temporal lobe.

Most large case system studies show that about 25% of cavernous hemangioma lesions are located in the posterior fossa, with the majority in the pons and cerebellar hemisphere. Spinal cavernous hemangioma is an intramedullary lesion, primarily seen in the cervical and thoracic levels. Thɪs chapter is updated by novel⁂fire.net

Subtentorial cavernous hemangiomas typically present with bleeding and progressive neurological dysfunction. Brainstem lesions manifest as cranial nerve disease and long tract signs. Because this region contains numerous important nerve nuclei and fiber bundles, progressive neurological decline can occur. Therefore, the natural course of brainstem lesions is worse than other locations. The hemorrhage rate for brainstem lesions is 2%-3% per year, and the re-bleed rate can be as high as 17%-21%. 39% of patients may exhibit progressive neural function decline.

Cavernous cerebral hemangiomas are an abnormal vascular cluster composed of numerous thin-walled blood vessels and are a type of congenital vascular malformation. Its pathological features include cavernous spaces lacking muscular and elastic layers, often accompanied by calcification and hemosiderin deposition.

These blood vessels are inherently poor, and encountering other diseases that affect the vessel walls is simply adding insult to injury.

“There is no other way now; it can only rely on one’s basic skills in separation. Don’t hurry, take it slow. The more difficult it is, the more patient one needs to be, and be sure not to damage the brainstem tissue.” Yang Ping finished reading the films and understood the basic condition of the patient.