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  The doctor must keep the whole process smooth and unobstructed, and reach the target lesion without getting lost. It must be like driving a car and must first find out how to walk.

How to take this surgical approach, such as other types of surgery have conventional practices (if you use a car map for navigation when driving), and have the experience of peers and own surgery to accumulate (have other drivers pass on experience or have driven such a road by yourself) experience as a base).

   There are two conventional positions for the transnasal approach, one is the supine position and the other is the semi-sitting position.

   Just look at the back position of the patient and know 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 was mentioned earlier, and it enters the brain through the nasal cavity through the special anatomical orifice of the sphenoid sinus.

   Contrast gastroscopy with colonoscopy.

  Gastroscope and enteroscope is a doctor\'s tool like a snake walking around in a tunnel. There is an advantage to going through the tunnel. When you go wrong, you step back and go forward. As long as you don\'t hit the wall, there is no high risk.

Sphenoid surgery is not. After passing through the sphenoid sinus, the surgical instruments go directly into a ball of "tofu". Since you don\'t go through the tunnel, you need to open the "tofu ball" again, which is very easy to accidentally hurt the surrounding. The "bean curd brain".

   It is just that these adjacent "bean curd brains", which are easily injured by accident, are particularly important in anatomy, so the sequelae of the operation are particularly terrible.

  If the position is not right, if you run down and click, you will hit the brain stem. If you are not careful, you can directly kill the brain stem.

   moved up the point, hit the damaged optic nerve and blinded the patient.

   If he deviates from the midline and punctures the cavernous sinus and internal carotid artery, hemorrhage during the operation is sure to kill him.

   In order to avoid these terrifying events, the best way is for the doctor to reach the lesion in one step without further exploration after entering the "bean curd brain".

   To do this, the doctor needs to find the entrance angle of the sphenoid sinus and accurately operate the "bean curd brain", both of which are indispensable.

In front of   , the doctor can calculate the angle according to the imaging film, such as neural 3D navigation software.

   To do it later, it is too difficult for the doctor to use tools to adjust the angle.

If    is difficult to understand, it can be compared to taking a long-handled cup at home and brushing a strange-shaped cup with a narrow mouth and a long mouth. If you want to clean the stubborn stains on the bottom of the cup, and the brush can\'t reach it, is it actually necessary to adjust the angle of the cup early in the morning, so that the cup brush can easily touch the place.

  Adjusting the cup angle and placing it in neurosurgery is equivalent to adjusting the patient\'s head position. Therefore, with the above-mentioned transsphenoidal surgery, the head is high and the feet are low. The exact height of the head will be tested by the doctor\'s calculation in the previous step.

   Not all doctors can accurately calculate it, and more clinicians use a large number of clinical guinea pigs to make sacrifices to accumulate experience.

   A doctor with a particularly high IQ can be counted without a mouse. It\'s a pity that doctors who can achieve this perfect goal are rare.

   "onlyoneoperationposition?"

   (Is there only one surgical position?)

   Dr. Charlie raised his finger to Dr. Tong to verify whether it was really one position throughout the operation.

   As mentioned above, it is difficult for doctors to determine the entrance angle of the sphenoid sinus for a good transsphenoidal approach. The determination of the transcranial surgical approach, as mentioned in the previous surgical examples, is equally difficult.

   (end of this chapter)