神经外科手术要点

刘*荣

以下是国际著名神经外科医师 Ossama Al-Mefty  博士提出的神经外科手术的若干要点，对青年神经外科医师极具参考价值。强烈推荐！
惟恐翻译水平有限，故将原文同时列出。  
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1. Remove the bone, leave the brain alone. 切除颅骨而不是脑组织。

2. An  arachnoid membrane is your best ally. Always do your dissection within the  arachnoidal planes. 蛛网膜是你的盟友。要在蛛网膜间隙分离。

3. Microsurgical technique is  indispensable in the surgery of meningiomas. Master it. 显微外科技术对于脑膜瘤手术是不可缺少的。掌握它。  

4. Sharp dissection is the safest dissection. 锐性分离是最安全的分离。

5.  Never pull or force anything. "Gentle, brother, gentle." 绝不推压或牵拉任何部位。“哥们，温柔点。”  

6. The anatomy of the skull base is complex. Learn it in the laboratory  before going to the operating room. 颅底解剖很复杂，要事先在实验室进行学习。

7. Seek total  removal with zeal during the first operation. It is the patient's best chance  for cure. The best time is the first time. 在第一次手术中积极寻找完全切除的可能。第一次手术是患者获得治愈的最佳时机。  

8. The use of the power drill is indispensable. Practice it.  磨钻的使用是必不可少的。多进行练习。

9. Be a vascular surgeon: preserve, repair, or  reconstruct vessels. Life and function run through them.  做一个血管外科医师：保护，修复或重建血管。生命和功能在血管中流动。

10. Veins are more vital than they are  usually believed to be. Preserve them.静脉比想象的还重要。尽可能保留。

11. Preserving  perforators is the greatest technical challenge and is crucial for preserving  function. 保护功能区是最大的技术挑战。

12. Maintain normal cerebral perfusion pressure  by avoiding hypotension and cerebral retraction. 维持正常脑灌注压。

13. plan the  closure before the opening. 手术前要计划好如何结束。

14. Repair defects with  vascularized tissue. 修复缺损要用带血管蒂的组织。

15. A tumor destroys the normal  anatomy. Always be on the lookout for displaced structures. It is better to say  "there it is" and be wrong a hundred times than to say "there it was" and be  right once. 肿瘤会破坏正常解剖关系，要始终留意移位的结构。说错“它在这儿”一百次也比说对“它曾经在这儿”一次要好。

16.  Preservation is the best means of reconstruction. Save every structure.  保留是重建的最好方法。尽可能保留每一个结构。

17. Learn from others. It saves you a lot of  grief. 向他人学习可以免除你的许多痛苦。

18. The little details, to the tail of the last  skin suture, are what make the difference. （治疗结果）差别存在于最小的不同，直到最后的皮肤缝合。  

19. Postoperative care is part of the operation and is equal to fine  surgical technique. 术后监护是手术的一部分，它和良好的手术技术同样重要。

20. Eliminate  intraoperative surprises; extensively extract all the ***rmation from the  preoperative studies. 手术前极力找寻所有信息，杜绝手术中的意外发现。

21. Intraoperative  monitoring is invaluable. Use it. 术中监护的应用很重要。

22. The success of surgery  is inextricably interwinded with flawless administractin of anesthesia. Team up.  手术的成功与平稳麻醉息息相关。

23. Above all else, the patient's well-being is your  duty. It requires your full commitment without distraction.  最重要的是，病人的安全是你的责任。你没有别的借口。