The next day.
9 a.m.
Operating room.
Today's surgery is the transcranial gangliorhizotomy.
Assisting Zhao Heng in the surgery is instrument nurse Tian Zhen, while standing by is Liu Ziang. Liu Haipeng, the attending physician from the pain department, is also present in the operating room.
This surgery, in theory, is quite simple: drill a tiny hole in the skull, then guide a monopolar coagulation probe through a catheter into the skull to precisely reach the location of the trigeminal ganglion. Through minimal coagulation and thermal effects, the ganglion is directly destroyed to achieve complete pain relief.
But it's only easy to say. The brain is the most mysterious and complex organ in the human body. Any surgery performed inside the skull is far from simple and carries tremendous risks.
Moreover, the key point is that this surgery is performed under local anesthesia, meaning the patient remains conscious throughout the procedure.
Imagine drilling into the skull and directly burning the nerves while the patient is awake.
It can be said that the surgeon must not make the slightest mistake, nor can their hand tremble in the slightest.
"Doctor, after this surgery, I won't feel pain anymore, right?"
While Zhao Heng was preparing for the surgery, the chemistry teacher patient with one side of his face disfigured asked.
"Yes, the pain relief effect of this surgery is the best among all trigeminal neuralgia surgeries."
Zhao Heng nodded as he explained.
Due to the patient's physical condition, with extremely high-risk hypertension and heart failure at level two, general anesthesia was not an option.
Under local anesthesia, it is crucial to maintain the patient's emotional stability.
Indeed, the patient's emotional stability is a very important part of the pre-surgery preparation.
Not all surgeries can use general anesthesia, and some surgeries don't need it either.
Everyone's body responds differently; for some, general anesthesia causes certain effects on the nerves and brain post-surgery.
Therefore, in clinical settings, especially in anesthesiology, all anesthesiologists agree that general anesthesia is not used unless absolutely necessary.
"Prepare for sterilization,"
Zhao Heng instructed Tian Zhen, the instrument nurse standing nearby.
"Okay, Dr. Zhao."
Tian Zhen nodded and began disinfecting and draping the area Zhao Heng had selected on the head.
After disinfection and draping, the next steps involved administering local anesthesia and then drilling the hole.
For Zhao Heng, local anesthesia is straightforward, so he completed it quickly.
The subsequent drilling, however, is critical; the position for drilling must be extremely accurate. Otherwise, under local anesthesia, the patient's condition and emotional state cannot endure a second drilling into the skull. Therefore, it must be completed in one go.
Steadying himself, Zhao Heng held the mini cranial drill, selecting the location. Since only a slender catheter is needed, the hole is quite small.
Before he began drilling, Zhao Heng glanced at Liu Ziang standing beside him, who gave Zhao Heng a reassuring look.
Zhao Heng nodded to Liu Ziang, feeling much more at ease. He pressed the drill, and the high-speed rotating drill bit made a low "buzzing" sound, gradually breaking through the patient's skull.
The process was swift, and shortly, the drilling was complete.
Next, a monopolar coagulation probe was to be guided through the catheter to the position of the trigeminal ganglion and use microthermal effects to fundamentally destroy the trigeminal ganglion.
"Catheter."
Zhao Heng put down the drill and instructed Tian Zhen.
Tian Zhen promptly passed the catheter, which was connected to the electronic screen, into Zhao Heng's hand.
Zhao Heng took the very slender catheter and deftly inserted it through the cranial hole into the skull. Relying on the real-time 3D model of the patient's brain in his mind, Zhao Heng carefully navigated the catheter, gradually reaching the trigeminal ganglion.
"That's it, here it is."
At this point, Liu Ziang, observing the electronic screen, confirmed confidently.
Identifying whether the reached location is indeed the trigeminal ganglion is a crucial step in this surgery.
After all, inside the skull, all ganglia appear similar, with almost no visible differences to the naked eye.
At this moment, only a neurosurgeon with extensive experience can correctly identify the specific ganglion.
"Coagulation output 1.0, 0.5 seconds."
Zhao Heng nodded, instructing Tian Zhen.
Tian Zhen hurriedly set the parameters on the panel.
"Start output."
Zhao Heng spoke in a deep voice again.
Tian Zhen nodded and pressed the output button.
Sizzle!
The people present seemed to hear a very slight sound, the sound of the monopolar coagulation burning the ganglion.
Though faint, it was there.
The surgery was completed. Zhao Heng exhaled deeply but did not immediately withdraw the catheter from the skull hole. Instead, he asked the patient: "Does it still hurt now?"
Indeed, this surgery is straightforward and direct; post-coagulation, immediate feedback from the patient is required.
Moreover, such feedback, after the coagulation of the ganglion, is very direct.
"It doesn't hurt, it doesn't hurt."
The patient uncle mumbled.
"Try it with gauze."
Zhao Heng instructed Tian Zhen again.
"Okay."
Tian Zhen nodded, picked up a piece of gauze with tweezers, and said to the patient uncle.
"Now, I'm going to place the gauze in your mouth. Chew a few times to see if it still hurts."
Tian Zhen said.
"Okay."
The patient uncle responded in a deep voice.
Then, Tian Zhen used the tweezers to place the gauze in the uncle's mouth, and the uncle started chewing a few times. This was to test whether chewing would still trigger trigeminal neuralgia.
"Now I'll take the gauze out."
Seeing that the patient uncle had chewed a few times, Tian Zhen said.
"It doesn't hurt at all, not at all."
The patient uncle's voice was filled with surprise.
"All done."
Zhao Heng and Li Ziang exchanged a glance. The surgery was a success at this point!
Zhao Heng completed the final steps of the surgery. Just as he was about to send the patient back to the ward, the patient uncle asked a bit worriedly: "Doctor, I won't feel pain again in the future, right?"
"Rest assured, the surgery was very thorough. You won't feel pain again."
Zhao Heng nodded, affirming confidently.
"Thank you, thank you, doctor."
The patient uncle, with his head wrapped in thick gauze, said excitedly.
This trigeminal neuralgia had been like a demon, tormenting him for over ten years.
During these ten years, he had tried every method he could think of—even injecting strong acid—but nothing rid him of this demon.
But now, he was finally free.
Seeing the patient uncle being sent to the ward, Zhao Heng felt deeply moved.
As a doctor, the greatest sense of accomplishment comes when the patient's pain is relieved.
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