Chapter 157: We Remove Brain Tumors Too [2] Kanghyeok's chisel scraped against the white bone.
He hesitated for quite a while even after gripping the hammer.
It would be so nice if I had a drill.
Since coming to Joseon, Kanghyeok had already opened bone several times, but every time, it left him dissatisfied.
That feeling only grew stronger when he had to deal with a particularly difficult case like this one.
But what could he do?
A true craftsman was not supposed to blame his tools.
Kanghyeok filled the hand holding the hammer with strength.
"Hold him tight."
"Yes, yes!"
After warning Dolseok and Yeoni one more time, Kanghyeok brought the hammer down.
Clang.
With a clear ringing sound, the chisel began to bite into the bone behind Yoshitoshi's ear.
Crk-crk.
Strange noises sounded from time to time, and each time, chunks of bone crumbled away.
That was because the bone behind the ear, the mastoid process, was very different in shape and structure from the skull.
The mastoid process already contained air pockets throughout, so it broke apart far more easily than the skull.
Which also meant that if he made even a small mistake, it could go very badly.
There are a huge number of major structures inside here…
As he hammered away, Kanghyeok recalled a surgery he had observed long ago.
It had been an otolaryngology operation, and despite being the kind of surgery done by what people often thought of as a minor department, all sorts of people had crowded in to watch.
That was not simply because it was unusual.
It was because it had been a truly difficult and dangerous surgery.
"Did you all hear that just now? The sound of the bone grinding changed a little."
At the time, the professor had stopped drilling and turned to the audience.
There had been doctors from neurosurgery, general surgery, and other departments there, as well as quite a few otolaryngology specialists.
But Kanghyeok had been the only one who sensed the difference.
The mastoid process is…
As he kept hammering, Kanghyeok searched for the right word.
He had been a science-track student by nature, so he was nearly devoid of literary talent.
The best word he could finally come up with was crumbly.
Compared to that, the skull inside here is hard as stone.
He could not afford to miss that difference in feel.
From that point on, he would no longer be able to hammer away as freely as he was now.
Ting.
Just as he was thinking that, the quality of the sound ringing from the tip of the chisel changed slightly.
Kanghyeok's expression changed at once as well.
But Dolseok and Yeoni, who were holding Yoshitoshi's head in place, did not seem to notice the difference at all.
"From now on… he absolutely cannot move even a little."
"What? Ah, yes."
Yeoni and Dolseok were already holding him with all their strength from the moment they had begun.
So their answer could only sound perfunctory.
That irritated Kanghyeok.
"I mean it. Hold him properly."
"Yes, yes."
"You sound a little slack."
"We're not…"
"Anyway, do your best."
"Yes, Young Master."
Kanghyeok fixed his gaze on the tip of the chisel.
Then he began tapping the hammer with half the force he had used before.
Tok. Tok. Tok.
It was like watching a sculptor carve the masterpiece of a lifetime.
That was how Kanghyeok began removing the mastoid process surrounding the cochlea and the semicircular canals.
The work was not actually as difficult as one might have expected.
That was thanks to Kanghyeok's abnormally developed senses and his vast anatomical knowledge.
As expected, I really am a genius.
If he could have, he would have liked to show that old professor.
You spent decades training and can barely do this with a drill, but I saw it once over your shoulder and now I'm doing it with a chisel and hammer.
Unfortunately, the only people around him were painfully ignorant fools.
Judging by the way they failed to feel anything while watching this tremendous display of skill, they were clearly all complete dullards.
Tap.
While he was briefly distracted, an unfamiliar structure popped into view.
It was, with only a little exaggeration, about as thick as a pinky finger, and no matter how he looked at it, it was not a nerve.
This goes inward… curves around the mastoid process, then descends into the neck.
There was only one structure in the human body that could be in this position and shaped like this.
The facial nerve…! Damn it, I almost fucked this up.
If he had carelessly driven the chisel down into that, it would have been severed on the spot.
Then after the surgery, they would definitely have been looking at a truly horrific result.
Fortunately, the tip of the chisel had not pointed directly at the facial nerve.
It seemed to have scraped along the side a little.
This much should be fine, right?
Unlike some other nerves, it was fairly large, so it probably would not be a problem.
No, it had better not be.
Still, he was a little uneasy, so he decided to take it out on them first.
When he got angry, it made him feel calmer, and then the surgery went better.
Someone looking in might curse him for that.
But what could he do?
During surgery, the lead surgeon was king.
"Hey, hey. Are you two not going to hold him properly?"
"What?"
"He just moved a little!"
"Ah, yes, yes."
Dolseok and Yeoni tilted their heads.
No matter how they thought about it, there had not been any noticeable movement at all.
Even so, they nodded anyway.
Whenever Kanghyeok was holding a hammer, he was terrifying beyond words.
"Right, I'm going again. Hold him properly."
Ignoring the cold sweat running down his back, Kanghyeok continued hammering.
The more the hammering continued, the deeper the chisel went.
By now, he had long since passed the cochlea and semicircular canals.
This is it.
Kanghyeok examined the nerves that emerged separately from the cochlea and semicircular canals, then joined into one.
These would now be the auditory nerve and the vestibular nerve.
They were separate nerves, but their path was the same, and even the regions they governed were almost adjacent.
So if one developed a problem, the other often did too.
Just like now.
Tok. Tok.
With painstakingly cautious blows, Kanghyeok finally reached the point where the two cranial nerves branched out from the brain.
Something blunt and swollen had grown where there should originally have been a smooth canal.
It was a lumpy mass, and even a layman would have known at a glance.
This was bad.
Just as expected, it's a schwannoma growing from the vestibular nerve. I've never seen one this large before… this isn't a place that takes injuries either. He must have been growing this for well over ten years.
Kanghyeok clicked his tongue as he looked at the schwannoma, which was over two centimeters in size.
A schwannoma that large was hard to find even in the extremities of the body.
They were usually all removed before they even reached one centimeter, either for cosmetic reasons or because of impaired function.
"Hmm."
A groan slipped from Kanghyeok's mouth.
It was not something he deliberately let out.
It had truly escaped on its own.
He had expected it, but now that he was facing it directly, it was absurd beyond words.
"Is it bad?"
Yeoni asked, still holding the head in place.
In an unusually rare display, Kanghyeok shook his head vigorously.
"It's bad. No, not bad exactly."
At a glance, it clearly was not malignant.
If it had been cancer, Yoshitoshi would already be dead by now, would he not?
Histologically speaking, it was the kind of thing one ought to call a good one.
Because this was definitely a benign tumor.
Even pulling on it like this, it doesn't bleed, and it doesn't tear.
More than anything, the tumor capsule was holding firm.
If it had been malignant, the capsule would either have been absent altogether or already shredded apart.
"Is it good, then?"
"No, it's not good either."
Histologically, yes, it was favorable, but it was too large.
And its location was awful.
If a tumor this size had been in an arm or a leg, it would have been no trouble at all.
Dolseok could probably have cut it out by himself.
But now it was attached right next to the brain.
Worse, it was attached to the lower part of the brain.
That made access a nightmare.
Even now, only part of the tumor was visible.
The rest would have to be approached from below, from the neck side, to confirm it.
"Then…?"
"We still have to do it."
"Are we going downward now?"
"No. We need to do everything we can from here first."
Kanghyeok shook his head slightly and picked up forceps and micro-scissors.
The size of the mass visible from above was, after all, only about half of it.
But even so, he would feel better separating at least this much before moving downward.
That way I can make Dolseok useful too.
Today's Dolseok was going to have to play a more important role than expected.
Watching that dumb face of his made Kanghyeok's confidence drop sharply, but still.
Among everyone present, Dolseok was the one with the greatest individual ability.
How sad.
There had once been a time when Kanghyeok used fellow professors as assistants.
And now Dolseok, the peasant bastard, was his first assistant.
Kanghyeok let out a low sigh and turned his eyes back to the tumor.
"Dolseok, pull like this here."
"Like this?"
"Not that hard, you little shit. This is the brain, the brain."
"But… you told me to pull like this."
"Want to die?"
"Ah, no. Sorry."
Dolseok tilted his head and gently pulled on the brain.
The sensation under his fingertips was not pleasant at all.
The brain was much softer and more yielding than normal tissue.
"Ugh."
Yeoni was not in a much better position.
In fact, it was worse for her.
The tissue she had to retract was not the cerebrum but the cerebellum.
Since it was smaller, it moved even more.
"Hey. Don't let it wobble!"
"Yes, yes. This really is…"
"Hold it exactly like that."
"My hand is already going numb…"
"Endure it."
"Yes."
Using their suffering as fuel, Kanghyeok resumed the surgery.
Strictly speaking, a schwannoma did not actually grow out of the nerve itself.
It grew out of the nerve sheath, which meant that if things went well, the function of the nerve might still recover.
Though after so long, who knows what'll happen.
Considering the growth rate of a schwannoma, this tumor had to be at least ten years old, even at the most conservative estimate.
A nerve compressed for that long would have an uncertain prognosis for recovery.
That's not even the problem right now…
Everything would come after properly removing the tumor.
Fortunately, the work from the head side was not especially difficult.
That was thanks to the clean path he had already opened so neatly with the hammer and chisel.
"Good. That should be enough here… now let's go lower. You can stop pulling on the brain now."
"Yes."
"Wet some gauze and leave it here."
Dolseok immediately inserted gauze into the opening they had made.
He did not stuff it in too hard, but neither was it too little.
That was just about right.
"Like this?"
"Mm. Yes. That should do."
Kanghyeok nodded and moved toward the neck.
Now he had to tunnel upward from below.
He closed his eyes briefly and reviewed the main route in his mind.
The things I need to watch out for are the internal carotid artery, especially the branch going toward the head… and of course the facial nerve and accessory nerve. Other than that, just the smaller arteries.
There was no reason to worry about other structures.
Or rather, if I do have reason to worry about something else, then things have already gone wrong.
If some structure other than the ones he had just listed popped up, that would mean he had already caused an accident.
"Hoo."
After taking a deep breath mixed with a sigh, Kanghyeok picked up the scalpel and forceps again.
"All right, everyone, retract left and right."
"Yes, Young Master."
Approaching from below was even harder than approaching from above.
For one thing, this route followed the carotid artery rather than a nerve.
That naturally made him much more cautious.
A nerve was tied to function.
This, however, was tied directly to life.
Shhk. Shhk.
As he carefully dissected with the large scalpel, he could feel his own heart pounding vividly in his chest.
Even Yeoni, assisting beside him, could hear it.
So this really is that difficult.
Then should she not help even a little more?
Yeoni carefully retracted the incision left and right, making sure not to damage any other structure.
That was when something Kanghyeok had not seen before came into view.
It was a pulsing structure branching out from the carotid artery.
Anyone could have seen that it did not belong there.
"Oh, come on."
"What is it?"
"What is this doing here…?"
"What is it?"
"There's an aneurysm too. Damn it. Ha… I… really…"
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