Surgeons dressed as poor people in the Republic of China

The next step is the highlight of this operation, intraoperative positioning.

This is what makes this operation different from other craniotomies. Is craniotomy difficult?Disaster!But there are not no people who can do it, but it is definitely the first time in medical history to accurately locate the epileptic focus during the operation and then accurately remove the focus.

The EEG machine was pushed to the side of the operating table, and all electrodes had been sterilized in advance.

"Then let's start." Doctor Ye said.

He changed into a clean disposable glove, took the cortical electrodes and placed them in the lower frontal lobe, superior temporal gyrus, middle temporal gyrus, and inferior temporal gyrus.

The machine started to work with a "beep", and the sound of "zigaziga" echoed in the quiet operating room.

The pink temporal region is tender and slippery, and it moves with the patient's breath, which is very cute, but Ye Yibai and Carter, two white coats, do not have the slightest thought of pity and tenderness. The cortical electrodes are placed in the pink with red thread area, and the number markers are carefully pasted on it.

"Deep electrode." Ye Yibai said in a deep voice.

Dr. Carter almost took over Qiao Na's job at this time. Hearing this, he immediately handed the two white deep electrodes to Ye Yibai. He looked serious and excited, and wished he could pull out the film from the machine to see the result.

Dr. Ye took the two deep electrodes with a sharp front end, and moved his fingers along the temporal pole to the middle temporal gyrus. All the white coats present, including Dr. Carter, couldn't help but raise their hearts, especially those who had followed Ye Yi. Those who operated on Bai, they were afraid that Dr. Ye would puncture the patient's brain if he tried too hard. After all, this Dr. Ye had a history of tearing livers and kidneys with his bare hands.

At a distance of three centimeters and five centimeters from the temporal pole, Ye Yibai neatly inserted the two deep electrodes under the nervous eyes of everyone.

That's right, it was inserted... It was inserted like rice seedlings, each inserted 3.5 cm, very precise.

"This location is the location of the amygdala of the hippocampus. There are two electrodes, the amygdala at the front and the hippocampus at the back. The range that can be determined by the scalp EEG is relatively small, and it can only be confirmed that the epilepsy focus is in the anterior temporal region, but the brain cortex Maps are different, it allows us to position with millimeter accuracy.

The anterior temporal region of the brain can be broadly divided into the lateral temporal lobe and the medial temporal lobe. If the electrocorticogram shows that the epileptic focus is limited to one part of the lateral and medial sides, then we can preserve the inferior anterior temporal as much as possible. The other healthy part of the area is used to reduce the postoperative sequelae of patients and improve the quality of life of patients. "Doctor Ye explained.

Focus, focus, this is the focus!

No matter how ignorant the two students at Carter Hospital were, they could tell that this was definitely the point. The pens in their hands memorized "Shua Shua Shua", which caused Dr. Carter to look at them several times. After all, Carter didn't have a pen. To rely on the person on the Lancet for this case.

The two little doctors scribbled and wrote down every sentence, every word and even every pause of Ye Yibai's words, then raised their heads and asked cautiously: "Doctor Ye, don't you want to continue?"

Ye Yibai smiled, and looked at the data on the monitor not far away. The data was very normal, and he said, "Let's take a break and wait for the EEG results to come out."

At this time, the electric drill was too heavy, and there was no self-stop device, so it was completely controlled by the doctor. It can take half an hour to an hour. If the onset has not been monitored, the time may be longer. This is what Dr. Carter is good at, and Ye Yibai does not intend to do it all.

Although he didn't need to be on night shift since July, he was busier than before because of the surge of patients on hand. A patient's basic signs suddenly deteriorated yesterday morning, and Ye Yibai was woken up from the bed by the surgeon again. At noon, he wanted to take a nap for a while, but Wei Rulan's family members came to his office early to have a family talk, so he didn't close his eyes for more than five hours all day today.

Dr. Ye found a chair by the wall and sat down, leaning his back gently against the wall to rest.

Dr. Carter took over the task of intraoperative monitoring. They had discussed intraoperative monitoring before. In order to ensure that the EEG could accurately locate the epilepsy focus, Ye Yibai and Carter decided to implement intraoperative epilepsy induction after discussion. .

The induction direction is nothing more than electrical stimulation, drugs and intraoperative awakening.

Electric stimulation requires electric stimulation equipment. Ye Yibo didn't know if there were micro-current equipment in the 30s. Even if there was, he didn't want to test the technology and safety of micro-electric equipment in this era at all.

For drug induction, it is nothing more than intravenous injection of appropriate amount of thiopental, etomidate, propofol or methohexital and other drugs. Simple is simple, but Wei Rulan has symptoms of narcotic addiction, and rough drug induction may aggravate Wei Rulan's symptoms. Narcotic Addiction.

Then only the intraoperative awakening was left. Before the operation, Ye Yibai had consulted Wei Rulan, and Wei Rulan also chose the latter between drug induction and intraoperative awakening.

Henry started to reduce the dose 10 minutes ago, but he was still very nervous. This kind of awakening during the operation was the first time in his anesthesia or even in his entire career as a doctor. Although Dr. Ye had communicated with him before the operation, as a previous A professional anesthesiologist is the target doctor. He knows very well that if the dosage of the drug is not well controlled, intraoperative awareness is prone to occur.

Intraoperative awakening and intraoperative awareness are two completely different things. Intraoperative awakening is often used in neurosurgery for precise positioning or in order not to damage the functional area as much as possible. It is necessary to adjust the operation at any time according to the patient's immediate response, so as to awaken the patient from anesthesia. to cooperate with the doctor.

The awareness during the operation is due to improper medication by the anesthetist or the special constitution of the patient, causing the doctor to think that the patient has been anesthetized, but the patient is not completely anesthetized. They may not be able to speak, but consciousness and even pain are still there. Obviously, this kind of patients often have a great psychological shadow after the operation, and it can even drive a person crazy.

"Doctor Ye, according to the estimated dosage, the patient should wake up in 5 minutes." Henry said to Ye Yibai nervously.

Ye Yibai nodded when he heard the words, he got up slowly and walked back to the operating table.

"Lily, when the patient wakes up, you go to communicate with the patient, comfort the patient, and at the same time follow my instructions, see the patient's reaction to the instructions, and remind me immediately if something is wrong."

Lily subconsciously straightened her back, "Okay...Okay." Being woken up during the operation, half of her brain was opened. Just thinking about this situation makes people shudder, and this Ms. Wei actually agrees. Yes, this made little girl Lily look at this crazy Chinese woman with admiration.

Henry kept looking at the watch on the wall, showing the tension on his face undisguised. During the operation, the patient must be awakened without pain, comfortable enough but awake enough. He and Dr. Ye had already deliberated over the dose and dosage, but at this moment, he was still extremely nervous.

Five minutes passed quickly, and Ye Yibai looked at Lily.

Nurse Lily nodded vigorously, bent down and got under the operating bed.

Wei Rulan's surgery was performed on her side, and her entire head was covered under the sterile towel except for the operation area. Lily squatted down and got into the sterile towel, and whispered: "Wei Rulan, Wei Rulan, Ms. Wei, you can hear me ?"

Lily's Huaguo dialect has improved rapidly. In just a few months, except for a slightly strange tone of voice, her vocabulary is already sufficient for daily communication with Huaguo people.

"Ms. Wei, Ms. Wei Rulan..."

Lily repeated it tirelessly over and over again. From 5 minutes to 10 minutes, Henry kept confirming the dosage of his medicine, and his heart beat fast.

Except for Ye Yibai and Carter, the other doctors in white coats could see their nervousness even though they were wearing masks.

ten 1 minutes

Twelve minutes

Henry couldn't help looking at Ye Yibai, "Doctor Ye, do I need to adjust the dosage again?"

"hold on."

It is not easy to keep consciousness awake without pain. The proportion of all anesthetics must be very precise. With Henry's current state, Ye Yibai doesn't think he can temporarily adjust it better.

Twelve minutes

Twelve minutes and 34 seconds, Wei Rulan's eyelashes moved.

Lily squatted under the disinfectant towel, staring at Wei Rulan without blinking, and naturally noticed her tiny movement.She immediately became excited, "Ms. Wei, Ms. Wei Rulan, can you hear me?"

Wei Rulan opened her eyes with difficulty. She felt that she had no strength in her body. She opened her mouth and said softly, "Is the operation over?"

Her voice was very soft, but it was too quiet in the operating room, so her words clearly reached the ears of every white coat.

Henry clenched his fist with his right hand, swung his elbow down hard, and made a "yes" movement. Although he has always been calm, he is still a young man. He was awakened during the operation... Oh God, he actually did it, during the operation wake! ! !

If Dr. Carter can write an article "On the role of EEG in neurosurgery", then Henry can also write an article "On the role of intraoperative arousal in neurosurgery" with intraoperative awakening. In precise neurosurgery, its role is absolutely no less than EEG.

Especially for surgeries involving functional areas, such as language, reaction, and other functional areas, observing the patient's real-time performance and adjusting the operation at any time is definitely the best solution to reduce postoperative sequelae.

"Not yet, what we are doing is intraoperative awakening, Ms. Wei Rulan, do you feel any discomfort?" Lily asked seriously.

Because it was determined to wake up during the operation, Wei Rulan performed nasal intubation during anesthesia, so it did not affect her speech.

"I feel a little heavy, but everything else is fine." Wei Rulan said.

Lily let out a sigh of relief, but before she could let go of her heart for a long time, Wei Rulan probably felt that the posture was uncomfortable all the time, so she moved her head slightly.

The pink temporal region trembled slightly under the master's movement, the soft and slippery tissue shook like tofu, Laura couldn't help but took a step forward, spreading her hands flat, afraid that the pink and tender little Something fell out of Wei Rulan's mind.

"Ms. Wei! Don't move!! Your brain is still open! You will fall!!" Lily said anxiously.