Ruan Bin is well aware that collateral anastomosis involves almost all perforating arteries. The dorsal pontine blood supply is mainly provided by the inferior lateral anastomotic vessels of the midbrain, which are composed of the lateral branch of the superior cerebellar artery, the dorsal branch of the pons, the long circumflex artery, and the lateral branch of the midbrain.

The long circumflex artery directly originates from the lateral wall of the upper segment of the basilar artery or co-trunk with the paramedian artery, 1~2 branches account for 85%, 15% are emitted from the superior cerebellar artery, and run outward and posteriorly around the upper ventral part of the pont, often branching into the lateral posterior area of the pont, penetrating into the pons, anastomosis with the superior cerebellar artery bridge branch, and the terminal branch is distributed to the joint arm.

It's impossible to avoid it!

The experience in his mind told him to avoid most of them, and some of the arteries could only be crossed by arterial guidewires.

"Pick the biggest artery. ”

He already had the answer in his mind at this point.

At the same time, I also know from the experience in my mind that it is definitely safe and feasible to approach from this path!

It is also possible to avoid the biggest danger zones!

"From the basilar artery cephalad approach, through the bilateral posterior cerebral arteries that branch off from the posterior communication and superior cerebellar artery and the cisterna between the feet, and then through the posterior communication and superior cerebellar artery to the caudal thalamus ......"

Every step of Ruan Bin's movements, Luo Youhong and others watched nervously.

"Use the tiniest arterial guidewire, can you operate it then?"

"Yes, the tiniest arterial guidewire is too soft, I'm afraid I won't be able to pass through the tortuous branch artery!" Guo Deyong frowned.

"Don't worry, avoid it! ”

"There are no arteries here, do they pass through the brain tissue?" Mo Xuyan was stunned.

Ruan Bin continued to move in his hand, and said: "There is a branch artery in this part, I will call it Z branch artery for the time being, because the rotational angiography cannot be seen, so you think there is no branch artery here!"

"Hiss......"

"And how do you know?"

"It was found during the autopsy. ”

"Then you're going to do blind exercise now?" Luo Youhong was shocked.

"I can't show the image, so I can only do it blindly. Ruan Bin said lightly.

Everyone's jaws dropped.

This is also one of the difficulties of basilar artery aneurysm surgery, with the current technology, a small part of the branch artery cannot be shown by angiography.

At present, most of the original images obtained by intracranial aneurysms using 3D rotational imaging are analyzed by post-processing workstations, which can realize volume reproduction (VR), multi-plane reconstruction (MPR), maximum density projection (MIP), etc.

Generally, the MPR layer thickness is 0.1mm, the MIP layer thickness is 6~10mm, the two-color window technique and the threshold adjustment VR can be used for small vessel analysis. Lescher et al. showed that 3D rotational imaging and its reconstruction could visualize the long and short rotator arteries and perforator pontine arteries better and earlier than conventional imaging, and patients were exposed to lower radiation doses.

Showing that smaller pontine perforator arteries require a thinner layer thickness, about 3 mm, while MPR layer thickness can better visualize the basic anatomy of the basilar artery small branches, because these perforators generally curve downward towards the pons, and the use of thicker layers to reconstruct the small angiogram results in a decrease in the spatial resolution of small angiograms, and some small vessels cannot be shown from the overlap and distributed correctly.

In other words, because some of the branch arteries are too small and overlap, they cannot be displayed!

"Isn't that dangerous?" Mo Xuyan said with some concern.

Blind exercise, the branch artery blood vessel is so small, in case the arterial guidewire is pierced too strongly......

It's GG.

Ruan Bin now relies on almost subtle manipulation to operate blindly.

The arterial guidewire travels slowly through the branch arteries......

Innovative-grade technology, coupled with innovative-grade basic exercises.

Slow down, it should work.

A few minutes later.

"Whew...... It's over!" Ruan Bin breathed a sigh of relief.

"It's a nano operation!" the crowd was shocked again.

Ruan Bin's operation really made them envious!

At this time, Jin Zhiwei felt that this operation was very likely to be successful!

Ruan Bin inserted the delivery GDC platinum microspring coil guide wire with the guide sheath through the Y-shaped valve at the end of the microcatheter, so that the front end of the guide sheath was tightly connected with the end of the microcatheter, and the Y-shaped valve was tightened to fix the guide sheath.

Luo Youhong hurriedly and slowly pushed the GDC platinum microspring coil into the Excel-14 microcatheter, released the Y-shaped valve, and slowly pulled out the guide sheath.

Guided by the TV surveillance and tracer map, the GDC platinum microspring coil is slowly pushed in without resistance.

When Ruan Bin saw that he entered the aneurysm, he saw that it was coiled in a spiral shape, and said: "Close to the aneurysm wall in the shape of a net basket!"

"Understood!"

When the X-ray impermeable indicator on the delivery wire exceeds the second indicator of the Excel-14 microcatheter and overlaps it, it means that the electrolytic point connected to the GDC platinum microcoil has been sent out of the microcatheter into the aneurysm.

Seeing that there are no problems, the next step is to prepare for electrolysis.

Ruan Bin used a 20-gauge stainless steel needle to penetrate the subcutaneous muscle in the groin on the side of the puncture, and connected the front end of the black negative electrode connection wire of the GDC special DC electrolysis device with the stainless steel puncture needle (loop electrode).

Connect the micro hook at the front end of the red positive wire with the uninsulated luo body at the tail of the GDC platinum micro spring coil guide wire.

And insert the other ends of the positive and negative connection wires into the positive and negative jacks of the DC electrolysis device respectively. When ready, confirm the position of GDC in the aneurysm and the position indicated on the guide wire again under the video fluoroscopy, and then the electrolysis can be started.

Confirm that the microcoil has been released under the TV perspective, and slowly pull back the GDC platinum coil to guide the wire......

Remove the red electrode at the end of the guide wire and slowly pull the guide wire out of the microcatheter. Turn off the DC electrolysis unit until the aneurysm is tightly packed.

The surgery was successful!

"Succeeded?" Luo Youhong was a little incredulous.

"Like, it's like the blood vessels at the end of the aneurysm are plugged!"

"It shouldn't be broken. ”

"My God, have we succeeded in the development of a new technique?" Guo Deyong also said excitedly.

This is to lead the international rhythm!

"Ruan Bin, you have innovated a new technique!" Mo Xuyan congratulated.

"Don't be too happy, calm down and see how the recovery goes! Steady, steady, don't get excited. Luo Youhong was the first to calm down.

"Yes, yes, calm down, calm down. ”

"Do you want to write a paper?" "Do you want to write a paper?" Jin Zhiwei said with a hesitant smile.

"The paper doesn't need to be written so quickly, we have only completed an operation, and we also need to observe how the patient recovers after surgery, and return visits. We still need more patients' surgical accumulation, and let's see if the success rate of the 30 surgeries is high!"

"However, in a few days, we can publish our surgical case, I believe that many famous foreign doctors will be shocked, haha!" Luo Youhong continued.