Surgery Godfather

Chapter 2225: Chapter 1452: Let’s Chat on WhatsApp Later

Yang Ping pushed open the office door, and a faint scent of tea drifted out. He paused for a second, then saw a thermos cup on the coffee table, with a sticky note on the side, in Xiao Su’s handwriting: "New Longjing. Stop drinking cold tea all the time."

The corners of his mouth curved up unconsciously. He picked up the cup and took a sip. The tea was still warm; the fresh fragrance spread over the tip of his tongue, dispelling his fatigue.

The computer screen lit up. There was already a new email in his inbox, with imaging data attached, sent by Xu Zhiliang. Yang Ping opened the first CT image, and his brows immediately furrowed.

Dorsal medulla—this location was even more tricky than he had expected. The medulla is the lowest segment of the brainstem, controlling the most basic vital functions like heartbeat, breathing, and blood pressure. And "dorsal" means approaching from the posterior fossa, having to pass through the thick cerebellum and gently separate dense cranial nerves before reaching that forbidden zone less than two centimeters in diameter.

He went through the images one by one. A cavernous hemangioma—not a true tumor, but a cluster of malformed vascular sinusoids, squeezed together like a bunch of grapes on the dorsal side of the medulla. A hemorrhage is fatal, but so is surgery.

Yang Ping enlarged the images and measured carefully. The lesion was only three millimeters from the floor of the fourth ventricle, and less than five millimeters from the obex—the key center that controls respiratory rhythm. If the surgical knife deviated even slightly, the patient might never wake up again.

He leaned back in his chair and closed his eyes, constructing the three-dimensional anatomy in his mind. Posterior fossa craniotomy, split the cerebellar vermis, open the floor of the fourth ventricle, and then...

Then what?

From a dorsal approach, the view would be blocked by the cerebellum, and the operative corridor would be as narrow as a slit. From a lateral approach, he would have to navigate through a large number of cranial nerves and blood vessels, with equally enormous risk. From below, via the foramen magnum, the angle would be too steep.

There is no perfect approach; every choice is a compromise, and every compromise comes with a price.

Yang Ping opened his eyes again and sent a WhatsApp message back to Xu Zhiliang: "I’ve reviewed the images. Come to Neurosurgery at 2:30, and bring the family."

He put down his phone, finished the remaining Longjing, and rested for a while.

2:30 p.m., Neurosurgery Meeting Room.

Xu Zhiliang was already waiting there. Sitting next to him was a woman in her forties, haggard, with swollen, red eyes—clearly she had been crying for a long time. She held a bag in her hands so tightly that her knuckles had turned white.

"Professor Yang!" Xu Zhiliang stood up. "This is... the patient’s family member, Ms. Wang."

Yang Ping nodded and sat down on the opposite side of the conference table. He didn’t rush to speak. Instead, he turned on the projector and cast the imaging studies onto the screen.

"I’ll start with my assessment." Yang Ping’s voice was very calm—no comforting, no intimidating, just stating facts. "The patient has a dorsal medullary cavernous hemangioma. There have already been two hemorrhages. This time, the coma is due to a third bleed. The hematoma is compressing the vital centers in the medulla. Fortunately, the amount of bleeding isn’t large, so there is still hope for treatment."

He pointed at the image on the screen. "At this location, surgery can be done, and must be done. The risk is extremely high, but we will do everything we can."

Ms. Wang’s face grew paler and paler. She knew the risk was huge—many doctors had said so—but hearing it again still filled her with fear and tension.

"Then... then what if we don’t do surgery?" Ms. Wang’s voice was shaking.

"If we don’t operate," Yang Ping looked straight into her eyes, "the next hemorrhage could be the last. The timing is unpredictable—it could be in a few months, a few years, or tomorrow."

The Meeting Room was frighteningly quiet. Sunlight streamed in through the windows, casting dappled light and shadow across the desktop.

Xu Zhiliang cleared his throat. "Professor Yang, your... opinion is...?"

Yang Ping was silent for a few seconds, then answered clearly.

"My opinion is: surgery. Although the surgical risk is very high, please trust in our capabilities. We will try to reduce the risk to the lowest possible level. The surgery won’t be now. The patient has just had a hemorrhage; the brain tissue edema is severe, and the adhesions are severe. Operating now would mean a blurred field and a higher chance of injuring normal tissue. We wait two weeks—for the edema to subside and for part of the hematoma to be reabsorbed. The surgical conditions will be better then. This is also part of reducing surgical risk."

"But..." Ms. Wang grew anxious. "What if there’s another bleed in those two weeks?"

"That’s why we won’t schedule this as an elective surgery; we’ll prepare as an emergency," Yang Ping said. "The patient will be transferred to the Intensive Care Unit of our Neurosurgery department in Sanbo Hospital, under close monitoring. If there is another hemorrhage or hydrocephalus, we go straight to emergency surgery. If the condition remains stable, we proceed with the planned surgery in two weeks. This way, we get the best of both worlds."

Ms. Wang felt a slight sense of relief, because she had also asked around. Many people said that the Neurosurgery department at Sanbo Hospital was extremely strong, especially in brainstem tumor surgeries—among the best in the world.

Yang Ping turned to Xu Zhiliang. "In these two weeks, you lead the team in preoperative preparation. Three-dimensional reconstruction, navigation planning, intraoperative electrophysiological monitoring protocols—all of it needs to be refined to the smallest detail. Also, contact Anesthesia. This surgery will require intraoperative awakening; we need to assess the patient’s ability to cooperate."

"Intraoperative awakening?" Ms. Wang was startled. "You mean... you mean waking a person up with their head open?"

"Yes." Yang Ping explained, "The dorsal medulla is right next to the respiratory centers and cranial nerve nuclei. Intraoperative awakening allows us to monitor the patient’s breathing, swallowing, and language function in real time, so we can protect normal tissue to the greatest extent. Of course, if the patient’s cooperation is poor or the psychological stress is too great, we can opt for General Anesthesia plus electrophysiological monitoring instead, and at present we lean toward the latter. Our Neurosurgery department’s monitoring techniques in this field are world-class."

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