Discarding the removed eyeball would truly be a pity, if it could be replanted, that would be better, but replanting is extremely difficult. If there is enough length of the optic nerve after it has been freed, allowing the eyeball to move out of the way without obstructing the surgery, it is possible to replant.
However, there are difficulties with replanting. Once the eyeball is back in its socket, there is no space to perform vascular anastomosis.
Yang Ping had thought this through carefully. He designed a special window on the lateral side of the outer canthus, which could be used to anastomose the veins and arteries of the eyeball during replantation, thus avoiding the sacrifice of an eyeball, which would be such a pity otherwise.
The WeChat group had been active these past few days. John Ansen sent the fMRI images to the group, as well as the results of everyone’s discussions.
[Professor, our conclusion is to abandon surgery and use stereotactic radiosurgery---Gamma Knife treatment. Because there is no approach to directly reach the tumor, and forcibly cutting through the brain tissue that’s blocking it is very dangerous, it might result in death or severe disability.]
[Is the effect of the Gamma Knife as good as surgical operation?]
[Definitely not as good as surgery, but at least it’s safe.]
[Actually, there is another approach, although it’s a bit cruel, I’m not sure if you can handle it.]
[There’s another approach?]
John Ansen thought he had considered all possible approaches. How could he have missed one? Could there be a new approach?
Yang Ping: [Remove the left eyeball, enter through the orbit, reach the gap in the brain tissue surrounding the tumor, enter through the gap, and resect the tumor.]
John Ansen immediately began to mentally simulate the approach, considering which anatomical structures it would pass and which areas it could expose.
After completing the simulation, John Ansen had to admit: A stroke of genius!
Indeed, removing the eyeball to enter through the orbit was the safest route, sacrificing an eyeball to save a life — from a surgical standpoint, it was worth it.
John Ansen: [I see now, sacrificing an eyeball for life, brilliant!]
Yang Ping: [When removing the eyeball, cut off the arteries, veins, and other connections, while preserving the connection of the optic nerve. Through careful freeing, it should be possible to gain enough length to move the eyeball, lifting it out of the socket to clear space for the operation, and after the surgery, the eyeball could be replanted in the orbit.]
John Ansen: Replanting? [How would you anastomose the blood vessels and other connected tissues?]
Yang Ping: [Open a special window on the lateral side of the outer canthus specifically for anastomosing blood vessels.]
An ingenious and superb idea!
John Ansen didn’t know what to say; the brand-new approach seemed crazy and brutal, but it was indeed the only way. The Professor’s thinking didn’t stop there—he also considered the replantation of the eyeball, creating a special window for anastomosing blood vessels, which was another imaginative operation.
But John Ansen immediately fell silent, pondering how to implement such a novel and sophisticated operation?
[But—we’ve never performed such surgery before, nothing similar either; completing the tumor resection through such a small gap will probably be very difficult.]
[Also, I don’t know if ophthalmologists have ever performed eyeball replantation surgery; I need to ask.]
[Consider it like performing keyhole surgery through the orbit.]
[The key point of the subsequent ophthalmology operation is actually the vascular anastomosis; the crucial window must be properly created to facilitate microsurgery.]
In Professor’s view, everything seems quite easy.
The Professor spoke so lightly, yet John Ansen couldn’t achieve it.
[Professor—could you help?]
[Could you help by performing international surgery remotely?]
Yang Ping didn’t respond right away.
John Ansen was anxious, not wanting to miss such a learning opportunity, so he sent an emoji of a clasped hands gesture.
[Professor, please help!]
[Alright, I’ll reluctantly do you the favor.]
The others in the group had been lurking because the case was related to Neurosurgery, and they had nothing to add, but now they finally had the chance to speak up.
Robert: [In the future, we can’t always trouble the Professor to fly over for surgeries; we could also have patients come over to undergo a surgery.]
August: [If Professor going out for surgery is called ’performing surgery remotely,’ what do you call it when a patient travels a long distance to come to him for surgery?]
The group went silent again.