Surgery Godfather
Chapter 1063 - 872: Cerebellar Artery Bypass?

Chapter 1063: Chapter 872: Cerebellar Artery Bypass?

Gene tests from Sanbo Hospital are generally sent to Nandu Medical University Genetics Laboratory, a key national lab. The director, Lin Lan, is Su Nanchen’s fiancée.

Soon, Lan Xueping’s gene test results were out. Lan Xueping was diagnosed with SCA3 type, the most common form of hereditary spinocerebellar ataxias in our country.

Spinocerebellar ataxias, abbreviated as SCA in English, if strictly defined, should be considered a group of hereditary neurological diseases characterized by progressive motor coordination dysfunction and balance disorder due to degenerative changes in the cerebellum, brainstem, and spinal cord caused by genetic mutations.

Initially, doctors believed that the disease was inherited in an autosomal dominant fashion, but as research on the disease deepened, they found that its inheritance was not limited to autosomal dominant patterns. There are also several other modes of inheritance: autosomal recessive, X-linked, and mitochondrial.

Not only are there several modes of inheritance, but also many genetic subtypes. Researchers have discovered 33 types of hereditary spinocerebellar ataxias so far, most of which are caused by an abnormal repetition and expansion of trinucleotide repeats in the exons of the corresponding genes, leading to polyglutamine. The pathological changes are neuronal cell loss and glial proliferation, with mutant proteins containing polyglutamine forming intranuclear inclusions. Although the basal ganglia, optic nerves, and peripheral nerves can also be involved, the main sites of lesions are the spinal cord, brainstem, and cerebellum.

Li Guodong himself reviewed a vast amount of literature and compiled a table listing various genetic types, corresponding symptoms for each subtype, and a summary of the literature on various treatment methods.

Furthermore, Li Guodong also wrote a detailed review of this disease, retrospectively summarizing previous literature.

He even sorted out numerous failed drugs and methods used in the past, including them in his review.

After reading the review, Yang Ping was very satisfied. Such scientific thinking is very important for future work. As doctors, we need to adopt a rigorous work attitude.

When they had free time, they gathered again to discuss Lan Xueping’s surgical plan.

"Professor Yang, I’ve been thinking, why don’t we just use arteriovenous grafting directly? I analyzed these MRI scans all of last night. The diffusion images of the blood vessels show that these areas indeed have significantly insufficient blood supply. Why don’t we use arteriovenous grafting techniques like with the heart to improve blood flow here? Regardless of the cause, I think it should be effective,"

Li Guodong had a strong desire for research, and he had truly been studying these MRI images.

His question resonated with everyone, prompting Song Zimo and Xu Zhiliang to also ponder this issue. If vascular bundle grafting would increase damage to the cerebellum, arteriovenous grafting would not, and it could be done on the surface of the cerebellum or within the existing vascular malformations.

"Yes, I’ve been pondering this question too, and Li Guodong has raised a good point," Song Zimo responded.

Xu Zhiliang followed up, "I---was just about---to ask the same thing."

"It seems we’re all on the same page. I am now considering whether to use cerebellar artery grafting surgery, but to do so, we doctors will have to do much more work, and the risks will be much higher. We need to study the cerebellar blood vessels, review all previous outcomes regarding the anatomy of the cerebellar blood vessels, and determine the precise subdivision of the cerebellar blood vessels. We need to clarify what vessels supply the ischemic regions you just mentioned, and then we’ll be able to plan how to perform the grafting,"

Yang Ping just happened to be researching this question and took the opportunity to discuss it in detail with everyone, indicating that everyone was indeed very dedicated.

"Do you remember who was the first doctor to complete a coronary bypass surgery?" Yang Ping asked the group.

"Doctor Favaloro from Argentina!",

Song Zimo, Xu Zhiliang, and Li Guodong answered simultaneously.

They had a very clear memory of these facts, and only those deeply interested in medicine would pay attention to medical history. Otherwise, with anatomy, physiology, pathology, biochemistry, and so on already making heads spin, how could they have the energy to study medical history?

"Doctor Favaloro, when studying at the American Cleveland Clinic, had a roommate named Sones who was the father of angiography. At that time, Sones was precisely developing the technique for coronary angiography. Doctor Favaloro had always been fond of cardiac surgery, so he was particularly fascinated by images from coronary angiography. As soon as Sones completed a coronary angiography and produced new images, Doctor Favaloro would spend hours studying these images of the coronary arteries, researching the relationship between blood vessels and the myocardium. Influenced by his good friend Sones’ research on vascular angiography, Doctor Favaloro was convinced that coronary artery bypass grafting could treat stenosis or blockage of the coronary arteries."

"Doctor Li Min, do you know what specialty Doctor Favaloro applied to specialize in at the Cleveland Clinic before his fellowship?" Yang Ping suddenly asked Li Min, who was listening attentively to the lecture.

Li Min didn’t know this story, so he shook his head.

"Doctor Favaloro was previously working as a rural doctor in Argentina, a general practitioner. It was at the age of 40 that he applied on his own to go to the American Cleveland Clinic for advanced studies. He received approval from Cleveland and, at the age of 45, he completed the world’s first coronary artery bypass surgery there," Yang Ping introduced this legendary figure briefly.

What an inspiring story, Li Ming developed a keen interest in Doctor Favaloro’s story.

Yang Ping continued, "The first patient Doctor Favaloro operated on for coronary bypass surgery had an excellent recovery, which shows that some new techniques, as long as they are thoroughly researched theoretically, can be tremendously effective even without clinical validation. The Fontan procedure in cardiac surgery is the same; the first case also had a significant effect."

Initially, Yang Ping’s surgical plan involved the use of muscle flaps with vascular pedicles, which was more reliable, but the appearance of the surgical effect would be slower.

This might be good for doctors, as being conservative implies lower surgical risks. However, for patients, seeing immediate results can establish strong confidence.

To build Lan Xueping’s confidence, Yang Ping decided to change the method of surgery, maintaining the same decompression technique but using a faster and more direct arterial grafting for improving blood flow.

"Even the specialized books and papers in neurosurgery might not be as precise about cerebellar blood supply research as they are about heart blood supply, right?" Song Zimo asked.

Yang Ping nodded, "That is one of our difficulties. Just as Doctor Favaloro studied the relationship between coronary arteries and myocardium, we need to re-examine the arterial blood supply of the cerebellum. Because all the previous related research was never intended to guide cerebellar artery grafting, it naturally wouldn’t be as in-depth as heart research."

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