Chapter 526: The Impossible Artery: Pushing the Limits in Brain Surgery

Once the dura mater is opened, there’s basically nothing left to stop you—it’s a straight shot inside.

First, they start by draining the accumulated blood inside the skull.

Even though this is the simplest step, Director Wu Yongming moves with painstaking caution. Pulling out the fluid from inside the cranial cavity is a delicate task—it’s easy to make a mistake and damage key brain areas.

Deputy Director Lu’s brain situation is even rougher than most, making any slip-up even more likely—and dangerous.

Forget the other problems. Just dealing with these aged, hardened, and fragile blood vessels is enough to put any surgeon on edge.

Once most of the blood is out, the pressure inside the skull finally drops back to normal. Actually, it’s a bit lower than normal right now.

That’s because what used to be a sealed space now has two holes—it’s more like a partially open chamber.

In medicine, this is called fenestration.

For now, the operation moves ahead smoothly.

But trouble isn’t far behind.

Just draining the blood isn’t nearly enough. If you don’t stop the bleeding, the cavity will just fill back up in no time.

Director Wu Yongming tries to repair the ruptured vessel, but even basic debridement turns difficult—anastomosis is more than he can manage right now.

“No good. This vessel is way too close to the brainstem. The operating space is incredibly tight—I just can’t guarantee hemostasis with the endoscope.”

Beads of sweat the size of mung beans form on his forehead as he shakes his head again and again.

It feels like there’s some savage beast lurking ahead, blocking any way forward.

When it comes to regular surgery, everyone’s technical level is about the same. As long as you hit the standard, the operation’s usually a success.

In the words of a legendary old surgeon, surgery is just about cutting out the problem and patching things back together.

Of course, that was said back in the sixties.

Surgical medicine has moved far beyond simple stitching and excisions. Now there’s a world of new technology—artificial vessels, stents, even artificial hearts.

And even when you’re just repairing a vessel or tissue, it still puts a doctor’s skill to the test.

But repairing a blood vessel inside the cramped skull, and doing it by endoscope? That’s a nightmare-level challenge.

The brainstem’s right next door, surrounded by other critical brain tissue. If your nerves aren’t steady, your hands will tremble just trying to move the endoscopic arm.

No exaggeration.

Doctors—especially chief surgeons—take on enormous mental and psychological pressure during surgeries.

Because when anything goes wrong, the chief surgeon takes the blame.

“The damaged area on this vessel isn’t that big. The length is short, but it’s so close to the brainstem that operating is a nightmare. Wu, why not try a vascular stent for the repair?”

Director Gou Qiong offers his advice from the sidelines.

“If it were a small cerebral aneurysm, I could handle it with a spring coil. Larger aneurysms, a stent usually works. But this artery—it simply can’t take a stent.”

He keeps shaking his head, shutting down the idea.

Drilling into the skull and making an opening is first and foremost about draining the buildup and easing intracranial pressure.

Second, it’s for vessel repair and stopping the bleeding.

Not all vessel repairs are suitable for stenting.

First, stents are expensive. Second, they’re incredibly tricky to place—especially inside cerebral arteries. The difficulty is off the charts.

“How about this… You help me out and nudge the brain tissue above the bleeding spot upward a bit. Let me give it a try!”

Zhou Can spots the ruptured cerebral artery and his eyes light up with excitement.

His expression is a complete contrast to Director Wu Yongming—Wu looks terrified, full of dread, with nothing but uncertainty in his eyes. But Zhou Can radiates determination like an unflinching hero.

“Dr. Zhou, please be careful and know your limits! Really, don’t push yourself too hard. If it doesn’t work out, we can call another consult and discuss different surgical plans.”

Wu Yongming says that, but deep down he knows—there aren’t any other real options.

If they had a better plan, they’d have done it already.

With internal medicine, sometimes you might come up with alternatives. But when it’s an intracranial artery rupture, your choices are painfully few—just two or three ways to go.

“I’ll be extra careful.”

Zhou Can answers firmly, his expression solemn.

Taking over as chief surgeon, he first guides Director Wu to gently nudge aside the brain tissue. This takes some skill, but mostly it’s about steady hands and muscle—like holding a retractor.

Of course, with the endoscopic arm, it doesn’t take much strength.

Then Zhou Can tries maneuvering in the extremely limited space.

“No, we need a bit more clearance—another half centimeter should do it.”

“Alright, I’ll give it a shot.”

Director Wu clenches his teeth, eyes laser-focused, inching the brain tissue aside to make more room for Zhou Can to work.

“That’s it, no more. This is our limit. Move it any further and we risk serious brain damage.”

Director Wu doesn’t dare pull his gaze from the screen. His voice is tightly controlled, afraid that a slip might mean hurting the tissue.

Moving surrounding tissue in surgery—whether abdominal or cranial—is always damaging to the body.

After abdominal or chest surgery, it’s common for organs and tissues to become badly stuck together, causing lasting complications or even permanent damage.

Like after chest surgery, some people end up with long-term shortness of breath and chest tightness—just side effects that stick around.

There’s simply no cure, they stay with you for life.

The most skilled and experienced surgeons, when working in the chest or abdomen, always try to avoid touching anything but the problem area.

But reality isn’t always so kind—you don’t get to choose every move you make.

Take appendectomy for example—if you don’t haul out the intestines, how do you operate?

Even finding the appendix takes plenty of wrestling around.

“Keep this space right where it is. That should give us enough room.”

After measuring and checking, Zhou Can finally looks satisfied.

“Just to be clear, repairing this particular vessel will definitely cause a degree of damage to some tissue in the upper left area. But I believe the trade-off is worth it—these are not critical brain areas. The body has a remarkable ability to heal. Give it ten days, maybe half a month, and most of the damage will be as good as new.”

Not wanting to startle Director Wu or Director Ming Xin, Zhou Can gives them a heads-up in advance.

A surgeon’s approach needs to change with every situation.

Trying to repair an artery in such a tiny space is almost impossible. It’s like trying to do a three-point turn with a car on a road only two meters wide.

For most drivers—it just can’t be done.

But if you’ve got world-class driving skills, sometimes the impossible becomes possible.

That’s exactly what Zhou Can is about to attempt—pulling off a vessel repair nearly no one else could, in the tiniest of spaces.

“Is the risk manageable?”

Director Wu still doesn’t dare look away from the screen.

“Can’t speak for the unknowns, but I’m sure of this—any damage in this region won’t be fatal or disabling.”

Zhou Can answers honestly.

No one can ever make absolute promises.

Even a simple surgery comes with risk. And for this kind of endoscopic brain operation? The risks just go up.

“Dr. Zhou’s plan has a high chance of success!”

Director Ming Xin actually supports Zhou Can in taking this calculated risk.

Her opinion carries a lot of weight.

With her on board, Director Wu Yongming stops hesitating. “Go ahead and start. Don’t overthink it. Steady hands and a bold heart.”

“Understood! Thank you!”

Zhou Can nods and thanks both chief physicians.

Without their support, he never would’ve gotten this opportunity.

He carefully controls the endoscopic arm, cleaning the area, then moves to anastomose the ruptured vessel. Every movement is slow and steady—he’s got the calm that only a top-tier surgeon can muster.

It’s the same kind of composure as a general commanding troops in battle—surrounded by chaos, but never losing his calm.

【Suturing Experience +100. Ligature Experience +100…】

Experience rewards pour in—Zhou Can can barely keep up.

Each reward is a cool one hundred points at a time.

When it comes time to finish the anastomosis, every last bit of air and old blood has to be cleared out. Since Director Wu’s holding the brain tissue steady, making room for Zhou Can to work isn’t easy.

After all, a person only has two hands—it’s like trying to work with four, or even six. You can imagine the difficulty.

“If there’s air left in this vessel after the repair, that’s another problem.”

Zhou Can knows all too well: air bubbles in blood vessels—especially ones in the skull—can quickly lead to a deadly clot. It’s a ticking time bomb.

But Director Wu can’t move. Should they drill another hole and use a second endoscopic arm?

That would cause way more harm to the patient—and the equipment just isn’t available.

What should have been a minor issue in vessel repair is suddenly a real headache for Zhou Can.

“If the air’s not completely expelled, that’s a massive risk.”

Wu Yongming looks at the nearly-completed operation, and frustration fills his chest.

They can’t afford to take shortcuts.

All of them are top-tier surgeons, and details like these mean everything in the operating room.

Everyone’s wracking their brains for a fix.

“Maybe we can try this—I’ll leave the final stitch untied for now. When I’m ready, Director Wu, let go of the brain tissue and help me force out the air in the vessel, then I’ll tie off the stitch and finish the anastomosis.”

Zhou Can offers his solution.

Finishing the vessel closure takes more space, but he’s confident he can manage it here.

At most, it’ll cause a bit more damage to the left side brain tissue.

Not an ideal fix, but sometimes you don’t have a better choice.

Besides, that part’s already seen some trauma. What’s a little more at this point?

“Great idea.”

Wu Yongming agrees enthusiastically.

They move forward with Zhou Can’s surgical plan, tackling the last step.

The final stage of tying off the suture is even tougher than expected.

But thanks to Zhou Can’s mastery of level six ligature, he manages to pull it off.

【Ligature Experience +1, bonus experience 1000. Anastomosis Experience +1, bonus experience. Pathology Diagnosis Experience +…】

Staring at the massive experience points rewarded after the surgery, Zhou Can freezes for a moment.

Then, understanding clicks into place.

It seems that innovating in surgery—or crafting totally new approaches in brutal situations—brings huge bonuses in pathology diagnostic experience.

Pulling off new surgical tactics in nearly impossible circumstances nets you a ton of rewards.

Back when he invented an aortic dissection method so the patient wouldn’t need a replacement, Zhou Can also scored massive diagnostic bonuses.

One thing is clear—medicine, whether internal or surgical, ends up relying on the same fundamental skills.

Raising Zhou Can’s level in pathology diagnosis.

Simply put, pathology diagnosis equates to a doctor’s core diagnostic skill and their way of thinking through treatments.

Pharmacological reasoning and surgical techniques are like two sharp swords for curing illness.

They’re the weapons that slay disease.

But no matter how powerful the weapon, in the hands of someone who can’t use it—it’s wasted.

Would a three-year-old with a butcher’s knife be able to butcher a chicken or duck?

They’d probably hurt themselves before figuring it out.

In the hands of a strong man? That knife is more than enough for a wild animal.

But if given to a true martial arts master? It could cut down a tiger, maybe even a dragon.

So, raising your diagnostic skill matters even more than boosting pharmacological or surgical levels.

One is knowledge, the other is the weapon.

But after Zhou Can’s pathology diagnosis reached level six, every step higher gets exponentially harder.

A million experience points seems almost impossible to reach in a lifetime.

But these big ten-thousand-point jumps? Gathering a million isn’t so far-fetched after all.

And he’s already proven—time and again—how critical those diagnostic upgrades are. Level six is a whole leap beyond level five. He’s now at chief physician level: in clinics, consultations, even surgery, he’s on equal footing with the best.

This means that improving surgical skills through his Medical Experience System isn’t just surface-level padding.

If one day he manages to reach level seven in diagnostic skill, he’ll be among the top doctors in the country.

For now, he’s at the ordinary chief level.

Maybe you could call him an expert, barely.

Once the vessel is fully repaired, they run a perfusion test—everything checks out.

“Excellent! The patient’s vital signs are stabilizing. If there’s nothing else, we can end the surgery and send them to the recovery room.”

Director Ming Xin says.

The endoscopes are withdrawn. They suture the incision and close up the skull.

Good news follows immediately.

“The patient’s brainwaves are already shifting in a positive direction.”

Director Ming Xin can barely hide her delight.

For a comatose patient, regaining consciousness is the ultimate goal.