Release date: 2014-12-18
The brain stem has been regarded as a surgical exclusion zone, and the mortality rate of disability is extremely high; the mortality rate of cerebral aneurysms is more than 30%.
With the advancement and development of medical technology, there are many kinds of neurosurgery that can challenge the limits of human life exclusion zone, and the finer and finer the success rate is, the higher the success rate is.
Medical Director/Director of Department of Neurosurgery, Guangzhou First People's Hospital Cao Zhizhen
Where is the most complicated and mysterious part of the human body? The brain is definitely the first to bear the brunt. To operate in this area, for doctors, it is always a challenge to cross life and death. However, in recent years, with the clinical use of a series of advanced medical instruments and equipment, neurosurgery has made great progress: in the brainstem area where many doctors did not even touch it, it is now more and more In the past, a brain aneurysm that was dead for a lifetime has now been able to bring the patient back to life with a "clip"; the cerebral hemorrhage that had previously been craniotomy can now be done by simply inserting a thin tube into the patient's head under local anesthesia.
Text / Reporter Li Wei correspondent Wei Xing
Brain stem tumors: the forbidden zone can also move the knife
In many areas of the brain, the most important thing is the brain stem, because it is the life center of the human body, controlling many important functions such as breathing, heartbeat and circulation. Eight years ago, the 32-year-old Ms. Fang almost died because of a tumor that grew in the brainstem area. That year, Ms. Fang was on a business trip in Guilin, and she had a severe headache every night. It didn’t take long to stun her past. When she woke up again, she was already in the hospital bed and surrounded by her family. After consultation with a neurosurgeon in a number of large hospitals in Guangxi, a large tumor grew up in Ms. Fang’s brains. This situation has not been saved, and the family is ready to do something.
However, Ms. Fang’s mother was not willing to watch her daughter die like this. She came to Guangzhou with her daughter overnight and was taken to the First People’s Hospital of Guangzhou by an ambulance. According to Cao Zhiwei, director of neurosurgery who was responsible for surgery in the past, the patient's tumor was a hemangioma, which was relatively large and grew in the brains of the brainstem. When the patient was admitted to the hospital, he had oppressed the brain stem and caused a coma. If the patient was not operated, the patient might become a vegetative person or die because of a tumor rupture.
However, brainstem surgery is not a joke, brain stem bleeding can be fatal, and brain stem tumors in the past are considered to be surgical "forbidden zone", deep location, difficult surgery, easy to cause important structures in the brain stem Injury, "Slightly careless, the patient may have a heartbeat and sudden cardiac arrest. The chance of successful surgery is only 20%." Cao Zhizhen said, however, the understanding and cooperation of the patient's family gave the doctor great confidence. "They expressed any results. It’s acceptable, let’s do it boldly.â€
In the end, Ms. Fang became the 20% lucky one. The operation was very smooth. The doctor successfully peeled off the tumor from her brain stem and did not damage any brain tissue.
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Cao Zhizhen told reporters that Ms. Fang gave them great encouragement and inspiration in the same year. “She is the first brainstem surgery in our hospital, and since then, we have invested a lot of research and practice in this field. Now, 8 years later, we have successfully completed more than 30 brain stems. Surgery in the region has a success rate of over 90%."
Cao Zhizhen believes that the reason why neurosurgeons can successfully cross the surgical "forbidden zone" now, in addition to the doctor's technology itself, depends on the progress of various surgical instruments and equipment. Now, before the operation of the brainstem area for patients, a special magnetic resonance examination will be used to display the parameters of the tumor, the relationship between the nerve cellulose and the tumor, and the parameters are presented by the imaging technique. Good enough preoperative preparation. The increasingly advanced electron microscopy technology helps to expand the doctor's vision during surgery and make the surgery more precise. In addition, through the comprehensive electrophysiological monitoring during the operation, it is possible to make an early warning of any changes in the operation, so that the doctor can make corresponding treatment in time.
Cerebral aneurysm: surgery can be performed with a small opening in the brow bone
The 62-year-old Mr. Zhao suddenly fainted at home and was taken to the hospital by an ambulance. After imaging examination, Mr. Zhao’s brain artery grew a hemangioma. Due to the impact of blood, the tumor expands like a "balloon" in the blood vessels. Once it breaks, it will cause extensive cerebral hemorrhage, and the patient's life is at stake. According to Cao Zhijun, the mortality caused by rupture of a brain aneurysm is as high as 30%. How to block the vascular gap before it breaks is the key to treatment.
In the past, a situation like Mr. Zhao had to open a mouth of more than ten centimeters on the forehead. Now, with the development of an aneurysm clipping, the situation has changed dramatically. The doctor only needs to open a small incision about 4 cm near the patient's brow, from where it enters the patient's brain, with the aid of microscopic techniques, find the location of the hemangioma, and then use a special "clip" to clamp the hemangioma. "Neck", to prevent blood from bleeding again through the weak part of the aneurysm, while allowing blood flow to the blood vessels to resume.
To deal with cerebral aneurysms, there is an intervention method in addition to the surgery. This method is mainly for multiple aneurysms, that is, more than one hemangioma in the patient's head, it is difficult to complete the operation by surgery. The method is to use a guide wire to enter the body from the femoral artery at the base of the thigh, and to find the "old fossa" of the aneurysm through the carotid artery. A small spring like a hair is placed in front of the guide wire. When the spring enters the tumor, the doctor presses the "launching device" outside the patient's body, the spring curls and fills the tumor, and the tumor becomes solid. Blood can't break through the "balloon" of the tumor.
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Both surgery and intervention have their own advantages and disadvantages and indications, and sometimes they cannot be replaced by each other. Both methods are carefully "carved" on weak blood vessels, and a little carelessness will be abandoned. The prognosis of the patient depends on the severity of the bleeding, the degree of brain damage after the aneurysm rupture, and the recovery of the intracranial condition of the postoperative patient.
Brain hemorrhage:
Minimally invasive surgery drainage instead of craniotomy
The 51-year-old Zhang is a driver of an agency. A few days ago, I had a hot pot with my friends. A few glasses of white wine went down. Lao Zhang suddenly had a splitting headache and then stunned at the restaurant on the spot. After Lao Zhang was taken to the hospital, the situation was urgent. The doctor immediately applied the “micro-invasive directional drilling of the cranial hematoma to the hematoma.†The patient began to recover consciousness the next day after surgery, and basically recovered his life two weeks later. And ability to work.
Cao Zhizhen said that in the past, such cerebral hemorrhage was often treated with craniotomy. However, since the introduction of micro-innovative technology, craniotomy has gradually become a "past-style", "unless the area of ​​bleeding is particularly large, the case is particularly serious." This new method only needs to open a small hole in the patient's head. The bedside CT was monitored to find the bleeding site, and a small catheter was inserted to guide the hematoma out of the body.
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Compared with traditional craniotomy, this treatment has the advantages of no need for general anesthesia, intubation, craniotomy and blood transfusion, and can be performed under bedside and CT monitoring. Patients have shorter hospital stays, faster recovery, and lower costs, often requiring one-fifth of the cost of traditional craniotomy or conservative treatment.
Autumn and winter are the high season of hypertensive cerebral hemorrhage. The mortality rate of non-surgical treatment in the past is 40%~70%. In the past 10 years, with the development of minimally invasive surgery, the curative effect has been continuously improved, and the mortality rate has been significantly reduced to 3. %~33%. Experts say that seasonal changes and changes in external temperature can affect the normal metabolism of human neuroendocrine, change blood viscosity, increase plasma fibrin and adrenaline, and increase capillary contractility and fragility. "In a short time, the intracranial blood vessels can not adapt to such obvious changes, that is, the fluctuation of blood pressure, if coupled with some external incentives, such as fatigue, emotional agitation, drinking, etc., it is easy to cause cerebral hemorrhage."
Source: Guangzhou Daily
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