The Love Story of the Doctor
Patient

Abi and other colleagues did a physical check with Doctor Renold Humbert.

" The patient is diagnosed gestational hypertension doc, the patient comes in a state of fainting," said Abi.

Gestational hypertension is an increase in blood pressure that occurs after 20 weeks of pregnancy. This increase in blood pressure is generally not accompanied by the presence of protein in the urine or damage to organs.

" His blood pressure is steadily dropping."

" As a procedure, can the family be contacted ?".

" The patient's family is on their way here, doc, " Abi said.

" The patient has a tumor, the tumor is located under the cerebral cortex" Abi said.

What is cerebral cortex? The cerebral cortex or cerebral cortex is a thin layer (about 1-5 mm) that encloses a part of the cerebrum. This layer has a large surface area. Therefore, the cerebral cortex weighs almost half the weight of the brain.

" Invansive growth occurs, in the hemisphere of the brain, affects the brain lobe dock, and has given up the structure of the brain inside the dock, in addition to the tumor also spread through the corpus callosum" Abi said.

" And certainly infect other hemispheres of the brain, right Bi ?".

" Right doc".

" Glioblastoma is more likely to occur Bi."

Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord. This type of cancer is formed from cells called astrocytes that support nerve cells. Glioblastoma can occur at any age, but it tends to be more common in older adults. This disease can cause worsening headaches, nausea, vomiting, and seizures.

Glioblastoma, also known as glioblastoma multiforme (GBM), can be very difficult to treat and often cannot be cured. However, treatment can slow the progression of the cancer and reduce its symptoms.

" The patient has experienced a lot of blood loss docks, surgery must be done immediately."

" Right Bi, the surgery is very difficult, from the results of the rongen we see, the tumor is very deep and difficult to remove."

" As soon as the family agrees, we are obliged to try Bi. "

Abi nodded.

" If it's this patient, what do you think Bi ?".

" This patient had either an intracranial primary tumor or a metastatic cancer of the dock" Abi said.

Metastasis is a condition when cancer cells grow or spread from their place of origin to elsewhere in the body. Almost all types of cancer have the potential to metastasize, such as breast, prostate, lung, kidney and many more cancers

Primary brain tumors come from the brain tissue or cells themselves. While secondary brain tumors are brain tumors that occur due to the spread of brain tumors with location outside the brain or called metastases, for example from lung cancer, gland/goiter tumors, breast tumors etc.

Dr. Renold read the results of the rongen and Abi analysis.He was very amazed, Abi's ability was above the average doctor at his level.

" In his brain so much Bi's blood."

" Right doc".

" The prognosis will be bad Bi, Renold said".

Abi nodded.

" Must do a ventriculostomy doc."

" Right Bi, " said Dr. Renold.

Ventriculostomy or ventricular drying is a short surgical procedure on the head to insert a tool that serves to absorb cerebrospinal fluid that accumulates in the brain. This tool can be installed from the outside for a while or permananen.

Ventriculostomy is carried out in the ventricles of the brain, which is a collection of cavities in which cerebrospinal fluid is accommodated. Because of certain things, the ventricles may be obstructed or contain too much cerebrospinal fluid and make the intracranial pressure increase. Tools used in the ventriculostomy procedure will be left attached until the cranial pressure returns to normal.

Who Should Undergo Ventriculostomy and Expected Results

Ventriculostomy is recommended for patients who experience a buildup of cerebrospinal fluid in the brain. Cerebrospinal fluid is a fluid that is in the central nervous system (brain and spine) and acts as an additional protector for the brain cortex. Once released, this fluid is supposed to be absorbed into the bloodstream, to maintain ideal cranial pressure.

Cerebrospinal fluid buildup is caused by several conditions, including hydrocephalus, a term used when spacing conditions between ventricles widen and leave little room for fluid to flow or be reabsorbed. The visible symptom of this condition is an enlarged head.

Hydrocephalus is a genetic or acquired condition. Genetic hydrocephalus occurs during fetal development, while acquired hydrocephalus conditions usually develop after the baby is born. A special procedure performed to treat this condition, called a third ventriculostomy with endoscopy.

Intracranial pressure can be triggered by traumatic brain injury. This condition is an emergency, because intracranial pressure increases rapidly, increasing the risk of permanent brain tissue damage.

Ventriculostomy can be done to include drugs to treat brain disorders or in the ventricles. This procedure can be used to diagnose cerebrospinal fluid, which will recognize infections or other diseases that cause neurological symptoms.

The pressure on the brain is expected to immediately decrease and return to normal after the ventricular catheter is installed.

How Ventriculostomy Works

Before the procedure begins, the neurosurgeon will hold a pre-surgical consultation, during which he will evaluate the patient's overall neurological and physical health. If the patient is undergoing treatment, then he needs to stop taking drugs, especially those that trigger a deficiency or blood clots during and after surgery.

Generally, the procedure lasts for an hour and does not have to use a total anesthetic. Local anesthesia is enough to be injected on the scalp where the hole is made. The patient can also be given a sedative substance rather he feels really comfortable.

During the procedure, the patient lies on his back on the operating table. Some of the heads are shaved bald and cleaned, while others are closed. The surgeon will make a hole in the head by using a surgical drill tool to access the durameter. For certain conditions, this procedure is enough to correct cranial pressure. However, if the ventriculostomy needs to be continued, then a tube will be inserted directly into the ventricle and a sac connected to the tube. The patient himself will be connected to a system that monitors cerebrospinal fluid levels and brain pressure.

If the tube is only used temporarily, then the procedure is called external ventricular drying (EVD). If used forever, the procedure is known as a shunt. The tube will be inserted with stitches, while the catheter is in its original place.

Possible Complications and Risks of Ventriculostomy

One possible complication of a ventriculostomy is infection, which generally occurs due to injury to the surgical area. If the infection is not treated immediately, there will be sepsis or systemic inflammation, which can trigger organ failure. Another complication is bleeding. The patient is not recommended to touch the sac while it is still in the drying process.

The installed sac may leak due to too much cerebrospinal fluid being absorbed, a condition called hypotension that causes severe headaches.

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