Chapter 262

Episode 262. NS Conquest (2)

"What? First author?"

The first author's spot for such an extremely rare case usually... didn't belong to a dispatched resident like me.

Even the DADA2 diagnosis I made in Pediatrics last time ended up becoming Son Jong-woon's achievement, after all. Of course, I didn't get awkward with Son Jong-woon over that. I just ended it at the level of:

'I got you an SCI-level paper thanks to me, so buy me dinner.'

I figured this Neurosurgery matter would end similarly. No, to be perfectly honest, I thought I wouldn't even get any scraps.

The pride of surgeons who handle the blade is famous. On top of that, this wasn't a case of a rookie resident making trouble, but a resident from an entirely different department stepping on the chief professor's pride. So, I never even dreamed that they would give me some kind of academic achievement.

'...Is Professor Park Seung-woo the type to care only about merit?'

If so, it made sense. It meant it made sense if he was someone who unconditionally prioritized competence above all else.

"Yes, first author. What do you think, Dr. Han? I believe this will be a massive opportunity for you as well," Park Seung-woo continued, speaking with a hint of anxiety as if he mistook my silence—lost in complex thoughts—for a refusal. "An opportunity like this doesn't come easily. Usually, no matter how positive someone feels toward you, they tend to look after their own family first. Dr. Han, so..."

When a professor who is the titan of his field coaxes you like this, staying still would be a bit inappropriate. I hurriedly waved my hands and spoke up.

"Ah, no! Not at all! It is a huge honor for me. I’d love to. Writing a paper like this with you, Professor... Yes. It's an honor."

At those words, Park Seung-woo smiled.

"For now, let's head out and go to the conference room for a bit. Seong-hoon, you too."

At that, Hwang Seong-hoon’s face brightened up. They were calling him while discussing a paper? That meant they were going to give him an n-th author slot. Usually, anything below the second author didn't matter much, but even so, getting one's name on a super rare case report with fewer than 60 cases reported worldwide was a massive deal.

On the connecting walkway to the East Wing, Professor Park spoke first.

"Dr. Han."

"Yes, Professor."

I, who had just turned my head and was about to open the blue window, quickly closed it and turned back to the professor. Oh well... I could just get help with the paper later when I was alone.

'It's not like I need immediate help right now anyway.'

"What kind of papers have you written before?"

"Ah... you mean research papers?"

"Yes, papers."

I combed through my memory. Papers? To be precise, I had no recollection of publishing any major papers on my own. However...

'I did cause some crazy incidents at academic conferences.'

Ah, fond memories. As a first-year resident, I attacked a presentation by a doctor from Asung Hospital. As a second-year resident, while discussing the expansion of the emergency medicine physician's role, I got ripped to shreds like a dog and received a ban from attending conferences from the Section Chief.

Recalling those memories, I spoke up.

"Ah, I have one poster presentation, and..."

"A poster?" Park Seung-woo frowned slightly at that. "That's all you've written? A poster is... child's play. Is there nothing else besides a poster presentation?"

"I haven't written any grand papers separately, but I do have one oral presentation experience."

Even at that, Park Seung-woo's gaze didn't change much. Then again, there isn't a massive deviation in the level of content presented at Emergency Medicine conferences. Whether it's a poster or an oral presentation. While oral presentations do feature relatively high-quality research, it was ultimately a domestic conference. The limitations of a resident presentation session were distinct.

"What did you do for the oral presentation?" Park Seung-woo asked, seemingly thinking along those lines.

"An emergency laparotomy."

Following my words, the surroundings instantly fell dead silent.

"..."

Professor Park Seung-woo.

"..."

And the neurosurgery resident, Hwang Seong-hoon.

The two doctors lost their words and silently headed toward the elevator.

"Yes... that was my second-year oral presentation."

"...Impressive."

In the conference room next to the Neurosurgery doctor's office.

After finishing a quick lunch with lunchboxes, Park Seung-woo and I sat quietly in our seats, watching Hwang Seong-hoon’s presentation. For the record, the content Hwang Seong-hoon was presenting summarized the previous cases of the anatomical variation we had just operated on.

'He couldn't even eat properly because he was organizing that...'

Whether Professor Park had subtly pressured him or not, it seemed it felt too awkward for him to just sit around and eat comfortably.

"I will start now."

Professor Park and I nodded.

"The infra-optic A1, where the A1 segment of the anterior cerebral artery courses beneath the optic nerve, was first reported in 1959 by Robinson during a cadaveric dissection."

So it wasn't a variation discovered that recently.

"To date, only about 60 to 80 cases have been reported across global neurosurgery and anatomical literature, making it known as an extremely rare anatomical variation... well, it's not even well-known. It's just an extremely rare anatomical variation."

I was appalled by that fact. That meant that without even opening the patient's brain to check directly, someone had deduced and discovered this extremely rare anatomical variation simply by looking at the angiography results and 3D-CTA, comparing them with the primitive bone images.

'Just what kind of crazy ghost is he?!'

I already knew the ghosts of the Back-alley Gallery were incredible, but this was a bit different. An anatomical variation with fewer than 100 cases worldwide. Less than 100 cases!

I turned my head and conjured the blue window in the void.

Korean Slave 1: @MindyToTheBrain sir sir

Korean Slave 1: @MindyToTheBrain urgent ffs just what is this, gentleman?

At my urgent call, the ghost appeared, showing a highly annoyed reaction.

MindyToTheBrain: yeah what

Korean Slave 1: What do you mean 'what' ffs

Korean Slave 1: How on earth did you notice an anatomical variation with fewer than 100 cases worldwide?

Mes of the God: ?

BackInMyDay: ?

At those words, the other ghosts dropped question marks too. Right, even the ghosts would find this hard to comprehend—

Mes of the God: You can't even do that?

Let'sLaunchTheCatapult: I can proudly boast that I have memorized every single kidney case in the world.

ThoracicSurgeryFossil: I boast that I have memorized every single rare lung-related variation.

...

That's right.

'I shouldn't apply the standards of normal humans to these crazy bastards.'

I closed the window right then and there. Hwang Seong-hoon was diligently continuing his presentation.

"It shows an incidence rate of less than 0.01%, to the point where calculating statistics against the total population undergoing cerebral angiography is meaningless."

Less than 0.01 percent. And the ghost had memorized this.

"Around the 4th to 5th week of gestation, during the formation of the primitive cerebral vascular network, a transient vessel called the dorsal ophthalmic artery exists at the cranial base. In normal development, this vessel regresses, and the A1 segment should grow from the internal carotid artery into its normal position. However, this variation forms when an embryological error occurs: the dorsal ophthalmic artery fails to regress and forms an abnormal anastomosis with the anterior cerebral artery territory, while the actual normal A1 segment regresses."

In short, what was supposed to grow didn't, and what was supposed to disappear grew instead, completely reversing the situation. It was similar to the words I used when attacking Professor Oh Man-seok in the past conference. The part about embryonic development.

Professor Park Seung-woo turned to look at me with a shocked expression when it was revealed that what I said at the conference that day actually matched the developmental mechanism of that specific variation. He had likely guessed that the basis for my attack that day was fabricated or roughly speculated. Because to launch an attack using this kind of evidence, one had to either completely memorize the case, or talk while looking at the paper related to that case in real-time. It had to be one of the two.

However, given the nature of the conference at the time, cheating would have been impossible, so Professor Park seemed to have decided to view me as the former.

Hwang Seong-hoon’s expression wasn't much different. It was an expression as if he were looking at a monster.

"In the case of this variation, it originates from a significantly lower position than the typical internal carotid artery bifurcation."

Up to this point was what Professor Oh Man-seok had also succeeded in figuring out. The part where the anatomical variation was heading toward a lower position compared to a normal blood vessel. Professor Oh Man-seok had successfully guessed in one go that the anatomical variation was in a low position, using his tremendous intuition and experience.

However, he made one error. The vast majority of patients with low anatomical variations he had seen probably had no issues during surgery. Therefore, Oh Man-seok overlooked one thing: the fact that this anatomical variation could be a case that only had a handful of instances worldwide.

"Subsequently, instead of coursing above the optic nerve, it travels through the optic canal or a very narrow bony crevice between the skull base and the optic nerve, then rises vertically anterior to the optic chiasm to form the anterior communicating artery complex," Hwang Seong-hoon continued.

"Because patients with this variation have a sharply bent vascular course and pass through a narrow bony crevice, the hemodynamic stress applied to the cerebral blood vessel is different from that of a normal person. Due to this, the probability of a saccular aneurysm occurring at the origin of the abnormal A1 segment or the anterior communicating artery is exponentially higher."

If so, the situation where this patient was rushed to the emergency room was essentially inevitable.

"In the majority of actually reported cases, patients experienced a cerebral aneurysm." Hwang Seong-hoon caught his breath for a moment. "However, there is one greatest significance in this, today's case."

"What is it?" Park Seung-woo crossed his arms and smiled.

"The vast majority of cases reported in past papers failed to diagnose this variation at the pre-operative angiography stage."

That's right. It is usually very difficult to know such a rare case in advance. Even if one could notice it, they would only roughly guess the variation point heading downward, just like Professor Oh Man-seok.

"With 2D angiography alone, the blood vessel is hidden by bone, so it was simply dismissed as having a low origin. Therefore, in most descriptions of this variation, the operating surgeons performed a conventional craniotomy, became flustered when the A1 vessel that should have been above the optic nerve was not visible, and accidentally discovered the vessel compressed beneath the optic nerve."

In other words, in most cases, neurosurgeons failed to detect it beforehand. They performed conventional surgery, panicked because it wasn't where it was supposed to be, and mostly stumbled upon the vessel under the optic nerve by chance.

"Therefore, this case, which diagnosed the variation in advance all at once, will possess tremendous clinical value."