Therefore, the doctor is required to ensure smooth operation and not to accidentally poke the wrong place or cause bleeding, as that would constitute a medical accident.
Doctors need to keep the whole process smooth and unobstructed, and reach the target lesion without getting lost. Just like driving a car, they must first understand the way.
How to take this surgical route, such as the conventional practices for other types of surgeries (such as using an in-car map navigation when driving), and the accumulation of surgical experience of peers and one's own (having other drivers pass on their experience or having driven this route before as a foundation).
There are two conventional body positions for transsphenoidal approach: supine position and semi-sitting position.
Just by looking at the latter patient's position, you can tell that the supine position of the former patient can never be a horizontal supine position, it can only be a supine position with the head high and the feet low.
This is determined by human anatomy. The anatomical path of the transsphenoidal approach has been discussed before. It enters the brain through the nasal cavity through the sphenoid sinus, a special anatomical opening.
Compare gastroscopy and colonoscopy.
Gastroscopes and colonoscopes are tools used by doctors, like snakes moving back and forth in a tunnel. Walking in a tunnel has an advantage: if you go the wrong way, you can just step back and move forward. As long as you don't hit the wall, there is no high risk.
Sphenoid nose surgery is not like that. After passing through the sphenoid sinus, the surgical instruments go directly into a ball of "tofu". Since it does not go through a tunnel, it has to move back and forth, and the "tofu ball" needs to be opened again, which can easily cause accidental damage to the surrounding "tofu brain".
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It just so happens that these nearby "tofu brains" that are easily injured by mistake are particularly important in anatomy, so the postoperative complications are particularly terrible.
If you are in the wrong position and run down a little, you will hit the brain stem, and if you are not careful you may die from the brain stem.
If it is moved too high, it may damage the optic nerve and cause blindness in the patient.
If the operation deviates from the midline and punctures the cavernous sinus and internal carotid artery, massive bleeding during the operation will result in death.
In order to avoid these horrific incidents, the best way is for the doctor to enter the "tofu brain" without further exploration and reach the lesion in one step.
To achieve this, the doctor needs to find the correct entry angle of the sphenoid sinus and insert the "tofu brain" accurately. Both are indispensable.
Previously, doctors could use neurological 3D navigation software to calculate angles based on imaging films.
To achieve this later, it is too difficult to just ask the doctor to use tools to adjust the angle.
If it is difficult to understand, you can compare it to using a long-handled cup to scrub a narrow and long odd-shaped cup at home. If you want to clean the stubborn stains on the bottom of the cup, but the brush can't reach it, you should plan to adjust the angle of the cup in advance so that the cup brush can easily reach the place.
Adjusting the angle of the cup is equivalent to adjusting the patient's head position in neurosurgery. Therefore, the head-high and foot-low position is inevitable in transsphenoidal surgery. How high the head is depends on the doctor's calculation in the previous step.
Not all doctors can calculate accurately. Most clinicians practice by using a large number of clinical guinea pigs as sacrifices to accumulate experience.
Doctors with exceptionally high IQs can calculate without mice. Unfortunately, doctors who can achieve this perfect goal are rare.
"Only one operation position?"
(Is there only one surgical position?)
Dr. Charlie raised a finger to Dr. Tong to verify whether this was really the same position throughout the operation.
As mentioned above, it is difficult for a good doctor to determine the angle of the sphenoid sinus entrance for transnasal surgery. The determination of the transcranial surgical approach has been mentioned in many previous surgical examples and is also difficult.
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