Endoscopic surgery

The next day, just finished the shift early in the morning, Qin Feng did not go home.

The little girl was hospitalized yesterday and is now in the emergency department.

Today's job is to complete the discussion of the operation plan, and at the same time, the parents of the child will decide.

"Director Qin, I received your call early in the morning."

Qin Feng was sorting out the medical records in the conference room, when a smiling voice pushed open the door and entered his ears.

"Director Sun, I'm sorry to disturb you so early."

He quickly got up and took the initiative to meet him.

The person who came was Sun Wenhong, the deputy director of the Department of Pediatrics. She was in her fifties and was amiable.

"It's okay, I heard from Dr. Zhu that it's a little girl with a hypothalamic hamartoma."

"Yes, otherwise I wouldn't trouble you to come over."

Qin Feng nodded.

"Well, this case is indeed very valuable. Although we are well-known in Xiehe, pediatrics is indeed not strong in the whole country.

The best place for hypothalamic hamartoma is Xiangya Hospital, even here it is not as good as others.

But you still kept the patient, it seems that you have a well-thought-out plan, hehehe~"

Sun Wenhong nodded kindly and smiled.

"Director Sun, you have a high opinion. Although this is a neurosurgery operation, the patient is still in the category of pediatrics.

Even in Xiangya, the department of pediatrics is in charge of it, and the surgeon is the master. "

Qin Feng immediately changed the subject when he heard the words, and pushed all these to Sun Wenhong.

"Director Qin has a bright future, hahaha~"

Sun Wenhong smiled even more when she heard this.

Qin Feng does have selfish intentions!

But not for himself and the emergency department, such a case is indeed a rare opportunity for pediatrics.

Including it was also the first time he encountered it. Although there are countless memories in his mind, it is always different for him to get started.

"Two directors, what are you talking about so happily?"

At this moment, Director Pan from the Department of Neurosurgery also arrived.

"Pan, you came quite early."

When Sun Wenhong saw him, she also took the initiative to say hello.

"Sister, you're already here, why don't I hurry up?"

Pan Hai smiled and said politely, then looked at Qin Feng who was beside him,

"Director Qin, I heard that this time is a hypothalamic hamartoma? This is a rare opportunity.

Since you became the deputy director of the emergency department, the emergency department of our surgery has become much easier. Last time, I said that when the directors are free, please gather together. Thank you very much, hahaha! "

"Director Pan is polite, it should be."

Qin Feng nodded and smiled, then greeted the two of them,

"Let's sit down and study this surgical plan first. I want to hear your suggestions."

"OK."

"Everyone sit down."

The three sat down and began to check all the examination results and related cases of the little girl.

The surgical plan is a big issue related to the safety of the ultimate patient, so every step must be advanced in depth and with confidence.

Moreover, this operation is a relatively difficult surgical operation, mainly because of the special location of the tumor, and the risk is relatively high during the operation.

Due to the abnormal development of neuron cells, coupled with the surrounding connected brain tissue, the boundary is blurred, so the situation will become very complicated during the operation.

Often prone to tumor resection is not clean.

If the operation is inaccurate and more resections are performed, it will cause damage to other brain tissues and leave serious sequelae to the patient.

Therefore, for hypothalamic hamartoma surgery, there are currently three methods commonly used around the world.

Traditional treatment methods include direct craniotomy, pterional approach, subtemporal approach, or tumor resection through the interfornical approach of the corpus callosum.

There are also endoscopic resection of tumors by the third ventricle, these two types.

However, surgical resection has certain limitations.

From an electrophysiological point of view, hamartoma is a common epileptogenic focus. Generally, children will appear gleeful, and severe cases may be accompanied by generalized tonic-clonic seizures.

Especially the epileptogenicity of the edge of the tumor is very strong. If the surgical removal is not clean and there are residuals, the problem of precocious puberty will continue to occur, and even associated epilepsy symptoms may occur.

"Director Qin, I think that although the tumor is relatively large, I still recommend trying SRT."

Pan Hai, the director of neurosurgery, studied it for a while and said,

"Director Sun, what do you think?"

"I also looked at the patient's condition in detail. Director Pan's SRT is indeed a solution, but I have a question."

Director Sun Wenhong pondered for a few seconds, frowning slightly,

"However, at present, SRT is targeting such a large tumor, and I am afraid that it cannot be eliminated once. If it is performed twice, will the risk be greater?"

Hearing this, Qin Feng also nodded.

SRT is a radiotherapy method, and it is also a common surgical method for hypothalamic hamartoma.

It is a treatment method mainly through non-coplanar multi-field unit cluster irradiation and multiple fractionation therapy, so that the target area can get a higher dose and reduce the dose received by surrounding normal tissues and organs.

It is mainly used for the treatment of brain malignant tumors and relatively large tumors, as well as various malignant tumors of the body, and belongs to the biological treatment method.

It has very obvious advantages.

High precision, precise positioning, precise design and precise positioning of the 3D treatment planning system are also called precision radiotherapy in clinical practice.

The most important thing is that it is non-invasive, safe, reliable in curative effect, less in pain for patients, and shorter in hospital stay.

Compared with conventional radiation therapy, normal tissue receives less dose, which improves the local control rate and the patient's quality of life.

However, the current domestic SRT is more suitable for treating hypothalamic hamartomas and has the best effect on tumors smaller than 2cm.

If the tumor exceeds 2cm, it usually requires a second targeted radiation.

But this is prone to a dangerous problem, the secondary radiation can cause damage to the peripheral nerves.

"But if it's a routine operation, even with an endoscope, it's extremely difficult and dangerous."

Pan Hai then said,

"Director Qin, what do you think?"

Seeing Pan Hai and Sun Wenhong looking at him at the same time, Qin Feng also expressed his thoughts.

"Both directors, in fact, for this kind of hamartoma, SRT is indeed the current international treatment method.

But what Director Sun said just now is not unreasonable, after all, the size of this tumor is difficult to destroy in one go.

If secondary damage is performed, the risk is actually not much different from surgical resection. "

"I personally prefer endoscopic resection."

After finishing speaking, Director Pan Hai slightly nodded in agreement.

In fact, there are only these two surgical options that can be chosen at present, it just depends on which surgical method is more suitable for the patient.

"However, if we choose endoscopic surgery, are we sure?"

Hearing this, everyone fell silent.

The biggest advantage of SRT is that the requirements for the surgeon are not strict, because the damaged electrode can be accurate to 0.5mm, and only the damaged tumor body needs to be placed.

And if it is an endoscopic surgery, it will be an extremely severe challenge for the chief surgeon!

This requires the surgeon to have a super high level of surgery, after all, the hypothalamus is the most important organ of the human brain.

Even if there is a slight error, it will cause serious sequelae to the patient.

And it's for life!

"Director Sun, can you complete the endoscopic surgery?"

Pan Hai immediately looked at Sun Wenhong.

"This... is really difficult."

Director Sun sighed, it was definitely a difficult challenge for her.

"The risk is too great, even our surgery department can't guarantee it."

Pan Hai also shook his head helplessly.

The connection between the tumor and the surrounding hypothalamus is too tight, and there is a slight error in the dissociation, which is all medical malpractice.

"Director Qin, you are a recognized surgical talent in our hospital, do you think we can do it?

If it doesn't work, then just give up. "

Sun Wenhong seemed a little disappointed, because even they were not sure about this operation.

This is too difficult!

As long as the tumor is small, it can be destroyed by SRT, and the hospital has this condition.

Qin Feng looked at the complex expressions of the two and showed a faint smile.

"Both directors, I can do this endoscopy, but in the end it is up to the family to choose whether to do it or not."

"Really?"

Hearing this, Sun Wenhong froze for a moment, and then a look of joy appeared in her eyes.

Qin Feng can do this operation!