Chapter 1582: Chapter 1168: Awake Craniotomy Surgery (Part 2)
75% of the world’s conjoined twins are joined at the chest and abdon, with connections at other parts being extrely rare.
For this pair of conjoined sisters, the situation where the base of the skull and cervical vertebrae are joined is even rarer; there’s no report in the literature, making the challenge for Yang Ping apparent.
The scientific training has made Yang Ping not just a doctor who treats and performs surgery, but also a doctor capable of solving unknown problems, because he is a scientist among doctors, not simply a surgical craftsman.
In previous surgeries on conjoined twins, shared organs weren’t truly shared but mixed-use between two sets of organs. For example, the stomachs are connected, and the surgery needs to separate the stomachs and repair the connecting tissues, as with other substantial organs. So-called sharing is due to interconnection through blood circulation or other pathways.
Thus, none of these organs are singular; there are two, not truly shared but mixed-use. If there is only one important organ, the twins can’t be separated – who would it go to?
This is also evident at the genetic level; conjoined twins result from the developntal disorders of monozygotic twins, so generally, they have two sets of organs.
Currently, this pair of conjoined sisters have their brainstem and spinal cord mixed together. If there were only one set, Yang Ping wouldn’t be able to perform surgery; now there are two sets, mixed together with unclear boundaries and unknown developntal status.
This mixed-use differs from other organ intersections, kind of like mixing apples and pears in a box is much easier to separate than mixing flour and rice powder. Yang Ping is now facing this challenging scenario.
Yang Ping is sitting in the doctor’s office, across from a specialized film reading screen, surrounded by other doctors. Many pre-surgery discussions are completed in this manner.
Thanks to John Ansen, Morris blends into the crowd, and no one notices him. Given he is Ansen’s friend, even if noticed, they may show so courtesy and not expel him.
“Other areas are manageable, but the anatomy in this region is extrely complex. So neural nuclei are very close, so might even fuse into one. We must precisely differentiate them; otherwise, the surgical consequences would be unimaginable.”
Yang Ping, pointing at the images on the screen, says, for him, others are not issues; only this point is temporarily uncertain – but only temporary.
The mingling neural nuclei are much more challenging than tumor surgeries in this region, which inevitably worries Song Zimo.
“Cervical vertebrae seem to be a difficulty too,” John Ansen shares his opinion.
Yang Ping says: “From the dulla below, the boundary of the spinal cord is fairly clear. As long as attention is paid during surgery not to damage nerve bundles and neural nuclei, after separating the cervical cord and cervical vertebrae, so segnts need stabilization through fusion, and the defective skin will be covered with augnted skin.”
John Ansen understands these are issues for him but not for Professor Yang.
“This is Director He’s large model illustrating the location, boundary of the neural nuclei, and suggested surgical approach.” Song Zimo again retrieves the three-dinsional brain image constructed by the large model.
John Ansen and Morris are both startled, not expecting China’s AI developnt to be so advanced, leading in dical applications. The United States also has similar AI models but lacks such a substantial dical model due to not housing a digital human as the base.
Yang Ping carefully examines the AI-delineated boundary, which roughly matches his own delineation. The crux lies in those mixed and chaotic areas that even AI may find hard to depict accurately, as it relies on input data for its judgnt, data which may be insufficient or distorted.
“How is it? Is this boundary accurate?” Song Zimo asks.
All eyes turn to Yang Ping, as despite AI’s prowess, this is its first application in such a scenario which, lacking practical experience, leaves everyone uncertain about its usability.
Other matters could be trialed, yet surgery cannot be experinted with; there’s only one chance. Even if the boundary is correct, a validation thod is essential.
This surgery on the conjoined twins isn’t imperative. Not performing surgery ans maintaining status quo existence, whereas life-threatening risks post-surgery for either could an a cost outweighing the benefit – it doesn’t adhere to the basic principles of surgery.
“Despite closely matching my depiction, we cannot assure its correctness. Both my depiction and the large model’s analysis are firsts without ample sample corroboration; such cases can’t possibly offer ample sample corroboration.” Yang Ping is thoughtful as he speaks.
“What then?” John Ansen asks.
“Such surgery is either not perford or executed flawlessly.” Yang Ping resolutely replies.
“But there’s no validation?” Song Zimo is also troubled.
Morris in the rear of the crowd is now sowhat anxious, this truly is a problem and an extrely perilous one. The reason no doctors in the United States recomnd such a surgery is due to the lack of clarity in the neuro-system boundary, rendering the separation of the skull base from the cervical vertebrae infeasible.
”Actually, I believe this boundary is very precise, but this is rely my belief, lacking objectivity; we need an objective thod for validation.”
A pencil twirls in Yang Ping’s hand.
John Ansen looks at the pencil, whose rotating skill he too learned as Yang Ping always had one swirling while explaining surgeries during the Mayo scalpel procedures he found cool, and followed suit.
Song Zimo watches the pencil in Yang Ping’s hand, knowing it signals rich experience. If the pencil is stationary, it indicates Professor Yang is contemplating, unresolved or uncertain yet.
If the pencil starts dancing in spins, it suggests resolution with sufficient assurance, as Professor Yang often claims eight-tenths certainty.
So, is this problem resolved judging by the pencil?
“Will the surgery proceed?” John Ansen is close, chin in hand, inquiring.
”It will… it will… certainly proceed…” Xu Zhiliang abruptly is anxious, deeming Ansen’s query unnecessary.
“Why would we all sit here discussing if not to proceed with surgery? It will obviously go ahead.” Song Zimo completes Xu Zhiliang’s words.
The ssage conveyed through Xu Zhiliang’s grateful glance.
Professor Yang never engages in futile efforts. He would not admit a patient for surgery only to later cancel; this has no precedent at the Institute.
Yang Ping remains silent; the pencil in his hand moves as if gifted with a soul, agilely switching between fingers, seemingly magical.
Morris finds the pencil’s dance srizingly cool, showcasing high finger dexterity.
“Actually, there’s an extrely primitive thod still, yet everyone overlooked it, focusing on advanced knowledge, neglecting primitive thod applications that sotis achieve unexpected effects.”
Yang Ping is silent for a mont before speaking.
There’s another thod?
The previously despondent group reignites hope.
“Of course, there is; this boundary is quite accurate; however, there are two issues. First, whether it’s accurate, remains unverifiable. Second, even if precise, it’s only an image; during surgery entering the skull and operating on brain tissue tasks conforming to the boundary.”
”Thus, utilizing a primitive neurosurgical thod will suffice.”
“Awake-state Craniotomy!”
Awake-state Craniotomy? Under local anesthesia? Performing brainstem surgery?
Everyone is astonished.
The most astonished of all are John Ansen and Morris, both top neurosurgeons, who have never encountered a doctor daring enough to operate on the brainstem in an awake patient state.
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