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| Name | Surgical Strike during the COVID 19 lock down – Aneurysm Surgery -"Saving Lives - Prof Chagla |
| Video Uploader | Video From aadilchagla |
| Upload Date | This Video Uploaded At 27-04-2020 10:57:38 |
| Video Discription | Surgery is an art in the medical profession mastered to save lives and therefore “Surgical Strikes” are meant to save lives and not the reverse …. We are the modern day “soldiers” again saving lives trying to protect humanity, toiling away under immense adverse physical and emotional conditions. I take you through an Emergency surgery performed at King Edward Memorial Hospital, Mumbai, for a patient with Sub Arachnoid Haemorrhage (SAH) caused by a ruptured Anterior Communicating Artery Aneurysm - during Lock Down in these trying times. The patient was discharged from the hospital with no deficits, completely relieved of his symptoms with a good prognosis only a few days ago. With fewer and fewer aneurysms being clipped today I thought I’d share a video of surgery performed using standard microsurgical techniques and I have tried to edit this video as less as possible to get the feel of the surgery performed. I like to use as high magnification as possible but this video has used a magnification for students of Neurosurgery to appreciate the anatomy and the way the surgery is performed. The pre operative CT angiogram shows the fundus projecting superiorly and slightly anteriorly as well. The aneurysm is approached from the left side as the left anterior cerebral artery is dominant supplying the aneurysm and the two A2s. A left frontotemporal craniotomy is performed and the lateral 1/3 of the sphenoid ridge is nibbled and meticulous hemostasis is achieved before the dura is opened The video starts with controlling bleeding from the sphenoid ridge with bone wax on a no.3 Penfield dissector and surgicel (oxycel) on the adjacent dura. I do not like to use bipolar coagulation on the dura as it contracts (shrinks) the dura. The dural margins are not coagulated but hemo clips are used to secure hemostasis as shown in the video as well. The dura is reflected towards the base and hitched on the temporalis muscle. The brain shows evidence of SAH and becomes lax as cerebrospinal fluid(csf) is let out by nicking into the arachnoid membrane and opening the sylvian fissure cistern (at times the membrane of liliequist may be opened into) There are many pearls that a surgeon uses and may be difficult to describe all in one video but I shall try my best to share all I can! NEVER FIGHT AN ANGRY BRAIN - Learn to use various manoeuvres to make the brain lax. I use a 2cc disposable syringe and a 21 no needle as my arachnoid dissector The biggest advantages of open surgery “versus” endovascular procedures is washing off the subarachnoid blood which occurs throughout the surgery with the repeated washes of saline and sucking of the “csf”; A “tight” brain can also be dealt with if required. The mass effect due to a clot or the aneurysm itself is managed at the time of surgery as well. And the surgeon is in complete control of the situation at all times under his “microscopic” eyes. The Left A1 is prepared for temporary clip occlusion. The Gyrus rectus is excised and the A1 A2 complex dissected. Only the neck of the aneurysm is dissected and not the fundus. A temporary clip is used when clipping the aneurysm to reduce the turgidity and prevent rupture while clipping. A forward curved clip is used to secure the neck of the aneurysm as shown: - complete occlusion of the neck with no compromise of any adjacent vessel namely the A2s or perforators is carried out. ICG is performed and the dura closed after verifying perfect hemostasis. The bone flap is anchored as shown using simple sutures. |
| Category | Education |
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