脑外科手术怎么做？

脑外科手术可以被理解为对大脑和脊髓进行的手术。在这里，您或许会问：脊髓手术怎么也包含在了脑外科手术之内了？实际上，脊髓在科学分类中，也属于中枢神经系统的一部分。神经科学家或心理学家所说的中枢神经系统，指的就是由大脑和脊髓组成的系统。

如今我们对脑外科手术有了一定的了解，但事实上，脑外科手术远比我们想象的还要复杂。其下甚至还细分出特定的领域，例如我们经常在电视上看到的神经肿瘤领域，以及我们不太常见的小儿神经外科、功能神经外科和神经血管外科等。这也就使许多神经外科医生只能选择一个领域。然而，无论是哪个领域的手术，医生们经常需要显微镜和机器人的辅助。

当医生开始动手进行脑外科手术时，他们首先需要切掉人最坚硬的骨头之一：头盖骨，做完手术后，再把头盖骨“钉”回去。切开头盖骨之后，医生就要对大脑进行手术了，不过得需要扫描仪和显微镜的协助，来准确定位大脑中的部位，毕竟与其他外科手术相比，脑外科手术的容错率更低。

如果需要进行手术的部位在大脑深处，那就需要脑部内窥镜了。跟用来进行内脏检查的内窥镜不同，这种内窥镜是专门用来进行脑外科手术的。医生通过头骨上的其他开口或鼻子等，用手或机器操作着把内窥镜送入大脑，内窥镜“管子”里装有一个极小的超清摄像头，并配有能够进行手术的工具，使得医生能直接在颅外进行大脑肿瘤切除手术。

在科技愈加发达的今天，医生有了另一种先进的手术工具，叫做“伽马手术刀”。然而它并非一把可以直接握住的刀，而是一束可以控制的激光。

激光拥有强大的能量，足以摧毁挡在它前面的任何有机组织，包括肿瘤。不过一条足以消灭肿瘤的激光也能伤害到其他健康的组织，这该这么办呢？我们可以把这条高能激光分成许多条相交于同一焦点的无伤低能激光，并使这个焦点位置与肿瘤重合。这样，也就只有焦点这个位置的能量强度能够杀死组织，于是乎，既消灭肿瘤、又不伤害到其他组织的目的就达到了。伽马手术刀也就根据这一构思而被制作出来的。

但就算神经外科医生有着多年的经验和比以往还要先进的手术工具，他们进行一场脑外科手术可一点也不轻松。

“危险”重重的手术

即便有了如此先进的技术辅助，脑外科手术的难度似乎一点也没减小，当医生进行脑外科手术时，仍然需要面对各种高难度挑战。

首先是感染。大脑也是人体的器官之一，跟其它器官一样，它也能被病毒、细菌或其他微生物感染，从而发炎。其它器官都有在手术中被感染致命的风险，更不用说人类最重要的器官之一——大脑了。

其次是手术时的额外损伤。大脑中布满许多细微的血管，所以在手术时，医生会用钳子“隔挡”住一些脑组织，进行一定程度的止血。在此过程中，大脑不可避免地会受到一些损伤；另外，大脑是非常精密的组织，即使是肉眼不可见的物理损伤，都会影响患者以后的语言、记忆和感觉等大脑功能。

第三是血块的产生和脑脊液流出的问题。医生在手术时会采取一些措施进行止血，但这有可能会导致大脑其他部位血管里的血液堵塞，从而凝成血块。血块又会反过来影响血液流通，进而影响大脑的功能和术后的恢复。另外，大脑内充满着一种叫做脑脊液的体液，正常情况下，脑脊液对大脑起保护作用，但脑外科手术会使一些脑脊液流到大脑外面，对大脑产生影响，从而使术后的病人头痛或视线模糊。

第四，在手术中，患者可能会突发癫痫，特别是在患者清醒的时候。一些脑外科手术会让患者保持清醒，因为大脑本身没有痛感，以及医生需要与患者进行交流，从而进一步确认进行手术的位置。正如我们剪头发时突然的喷嚏会让理发师出错，患者突发的癫痫极有可能也会让医生手术产生失误。头发被理错没关系，大脑的损伤却是不可逆的。

最后，也是最为沉重的风险就是手术失败。因为脑外科手术的对象是人类最为精密的器官，手术不顺利、甚至失败是常有的事情，所以，神经外科医生有时不得不告知病人家属坏消息。

尽管脑外科手术的医生在手术时会遇上诸多挑战，好在随着科技的进步，例如前面提到的伽马手术刀，以及正在不断发展的虚拟和增强现实技术。这两种模拟技术能使医生事先对电脑模拟的“你”进行多次手术，然后从中选择最好的方案实施。将来的手术成功率会越来越高。

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