Chapter 266

Episode. Real Genius (3)

“Are there any more questions?”

I could see several reporters and medical staff looking flustered at my words. Well, it made sense. The resident they had all written off as a fake genius—a product of hospital corruption and favoritism—had just flawlessly answered a question posed by a professor.

“.…”

“.…”

However, the look in the eyes of a few professors began to shift. It started as doubt, turned into curiosity after hearing my response, and now, seeing my confident demeanor…

‘Their interest has turned actively positive.’

Originally, many of the professors attending today probably assumed I was a fake genius who had snagged the first-author slot purely through the hospital president’s backing. If they hadn’t thought that, they wouldn’t have gone out of their way to come all this way just to test me.

But after listening to the briefing I just gave on the anatomical origin of the ophthalmic artery, the anomalous A1 segment, and the subsequent solution, their minds were changing. Doctors and a few reporters hurriedly jotted down notes or stared intently into their phones.

“Are there really no more questions?”

At my final prompt, a doctor standing in the corner raised his hand high.

“Yes, the doctor in the fourth row who just raised their hand.”

“Ah, yes.”

He stood up from his seat with an urgent expression.

“I am Yoo Euimin from the Department of Neurosurgery at Ulsan Aseong Hospital.”

“Yes, Teacher Yoo.”

Ulsan Aseong Hospital. It was one of the sister hospitals to Seoul Aseong Hospital, which was widely considered one of the top-tier medical centers in the country. The other was Gangneung Aseong Hospital, or something like that.

‘Which means that gentleman is…’

There was a very high probability that he was quite skilled. Well, to begin with, you don't become a university hospital professor by being just anybody.

“I listened closely to your answer to the first question.”

I bowed my head slightly at his words.

“Thank you, Professor.”

Beside me, Lee Jaeyoon, the Chief Medical Officer, was watching me with a proud grin, looking almost like a father watching his own son.

‘Why is he looking at me with a look like I'm his incredibly successful offspring?’

Maybe it was because a genius possessing both skill and a decent character was such a rare sight. Shaking off the thought, I faced forward again.

‘Man, if the ghosts were active right now…’

If a guy like Mes of the God or an old lady like Rheumatology Old Woman had heard this, they surely would have harassed me, saying, ‘Hell Slave, what on earth did I just hear you say?’

“Ahem.”

Ah, right. I momentarily lost focus on the questioner because I was thinking about the hospital president and the ghosts.

“Oh, my apologies.”

When I offered a brief apology, Yoo Euimin of Ulsan Aseong Hospital waved his hand as if to say it was fine.

“May I proceed with my question then?”

“Yes, please feel free to ask.”

At my invitation to ask freely, Yoo Euimin smiled and… began his attack on me.

“First, let us establish a hypothetical scenario.”

Yoo Euimin raised a single finger.

“A hypothesis, you say?”

[Comments]

Korean Slave 1 (Male): Out of nowhere, the second questioner wants to establish a hypothesis.

Mes of the God (Male): What kind of hypothesis?

Korean Slave 1 (Male): I don't know yet, he hasn't given the details.

PopOpenTheHead: Hey, you jerk.

I minimized the Gallery window again and shifted my gaze back to the doctor standing before me.

“Let’s assume that you have carefully avoided the anomalous A1 segment.”

“If so, this question concerns the dissection process during surgery.”

Yoo Euimin nodded in apparent satisfaction at my bold reply.

“Correct. Let's assume you successfully avoided it and located the root of the aneurysm…”

He began using both hands to vividly depict the cerebral blood vessels.

“In that case, wouldn't you then dissect the arachnoid membrane to clear away the thrombus at the skull base and expose the neck of the aneurysm?”

“Yes, naturally. It's a standard dissection procedure.”

To properly expose the neck of the site where the cerebral aneurysm formed, the surrounding arachnoid membranes must be cut away with scissors.

“During that dissection process, the patient's contralateral limbs could suddenly become paralyzed.”

‘…Paralyzed?’

A sudden onset of paralysis. Paralysis occurring during a standard dissection process where you're simply cutting the arachnoid membrane?

‘I have absolutely no idea.’

Was he hypothesizing a situation where the aneurysm suddenly ruptured? Or perhaps the deep basal ganglia inside the brain was accidentally disturbed?

However, as if mocking my shallow assumptions, Yoo Euimin immediately shattered my guesses.

“The aneurysm didn't rupture, and the brain parenchyma wasn't damaged, so why exactly can post-operative hemiplegia occur? I am curious to know how you understand this fact.”

Uh. Shit.

I held the microphone and calmly began to speak. Of course, the content of my speech was…

“Could you give me a moment to organize my thoughts?”

It was a request to buy time to cheat using the Gallery.

[Comments]

Korean Slave 1 (Male): He's asking why hemiplegia strikes.

PopOpenTheHead: Probably because they messed with the wrong aneurysm?

Korean Slave 1 (Male): Under the assumption that they didn't touch the aneurysm.

PopOpenTheHead: Ah, I see.

PopOpenTheHead: Got it.

Mes of the God (Male): I don't really know.

Korean Slave 1 (Male): That's because you're not in neurosurgery…

I relaxed my tension slightly upon seeing Mes of the God's useless comment, while waiting for PopOpenTheHead's upcoming reply.

Of course, to prevent the delay from looking suspicious, I tapped my head and scratched the back of my neck, doing my absolute best to give off the vibe of "I am thinking very deeply right now."

Ding-

[A reply has been posted.]

The moment I saw the notification, I looked down at the comment section.

[Comments]

PopOpenTheHead: Let me explain the anatomical principle of the Recurrent Artery of Heubner (RAH).

PopOpenTheHead: The RAH is a damn important blood vessel, you see?

‘Damn important blood vessel, check.’

I began organizing the core keywords and reconstructing them into my own words.

[Comments]

PopOpenTheHead: It's incredibly thin, and it makes a U-turn toward the back of the head from the anterior cerebral artery.

A blood flow that detours backward from the anterior cerebral artery. Check that too.

[Comments]

PopOpenTheHead: This thing supplies blood to the basal ganglia deep inside the brain. If it gets severed, the patient ends up hemiplegic.

In other words, the vessel called the RAH supplies blood to the basal ganglia deep inside the brain—essentially the absolute core of the motor nerves. I understood that part, but…

[Comments]

Korean Slave 1 (Male): Is this related to the infraoptic course variation?

PopOpenTheHead: Yeah, it is.

PopOpenTheHead: In a normal person, it runs beautifully and parallel along the A1 vessel.

In a normal person, this RAH vessel extends parallel along the A1 segment. If so, what happens in this variation where the A1 is positioned beneath the optic nerve…?

‘What happens?’

[Comments]

PopOpenTheHead: You've pretty much figured it out by now, right?

Korean Slave 1 (Male): Yeah.

PopOpenTheHead: Right. The A1 is forcefully dragged down beneath the optic nerve, right? Then what happens?

Korean Slave 1 (Male): Heubner's artery won't be able to stay in its proper position either.

‘So that was the intent behind the question.’

From the start, it wasn't a question asking about variables during the surgical procedure itself. It was a question asking whether I truly understood the butterfly effect that the A1 variation exerts on the surrounding structures.

[Comments]

PopOpenTheHead: Yep, exactly. Heubner's artery can't stay in its proper place either, so it either gets stretched abnormally taut, or it gets tangled up in the wrong arachnoid membrane of the anterior perforated substance.

‘Okay, got it.’

After translating the comment into my own words, I opened my mouth to speak.

“In an infraoptic A1 variation, the anatomical landmarks of the recurrent artery of Heubner completely collapse.”

The moment I began speaking, Yoo Euimin's expression grew peculiar, and as soon as the word 'Heubner' left my mouth, the corners of his lips turned upward.

‘I'm right, it's Heubner!’

I cleared my throat and continued in a voice filled with certainty.

“As the A1 is dragged downward, the Heubner artery is also abnormally stretched and becomes entangled with the wrong arachnoid membrane. In other words, if one cuts the arachnoid membrane blindly while expecting the textbook position as usual, it is highly likely that they will accidentally slice through the Heubner artery as well.”

Yoo Euimin nodded at my words. It was a proud gesture, much like a teacher looking at a disciple who had given a flawless answer.

“Yes… that is a perfectly correct answer. Thank you for the answer…”

But I cut him off. No. My answer isn't finished yet. You have to spoon-feed them the solution too if you want to be a true genius.

“Uh, yes.”

“Pardon?”

“May I continue with my response?”

At my request, Yoo Euimin nodded up and down with a dumbfounded expression.

“Therefore, the solution is to verify the posterior surface of the A1 under the highest magnification of the microscope before exposing the neck of the aneurysm.”

The absolute best method. Instead of clumsily poking around by gut feeling, you just have to visually verify it with your own two eyes and be careful.

“One must visually identify the origin of the Heubner artery, which is resting in an abnormal trajectory, and peel away the arachnoid bands layer by layer.”

Yoo Euimin looked utterly stunned. It was a natural reaction. What he had asked was why hemiplegia occurs, not what the solution was. Yet, because I had perfectly answered even that part, it was bound to surprise him.

“Ah… yes. Everything is correct. Thank you for your response, Teacher Han Hyeonjae.”

“Not at all. The honor was mine to be able to answer such an excellent question, Professor.”

Flattered by my compliment, Yoo Euimin smiled, sat back down, and began to jot something down.

It was then.

“Excuse me, over here!”

A harsh, hurried voice suddenly rang out from the press section.

“Yes.”

“May I ask a question?!”

The voice sounded considerably sharp and urgent. I took the question nonchalantly.

“I am reporter Choi Jeongcheol from Medical Health Times.”

“Yes, Reporter. Please go ahead.”

The reporter checked his phone and notepad alternately before tossing out a loaded question.

“By any chance, have the specialists gathered here sufficiently covered all the questions regarding this patient case currently displayed on the stage?”

It was a question directed not toward me, but toward the entire audience in attendance. When the hall fell silent, he nodded once as if the situation had played out exactly to his intent, and then turned his question toward me.

“If you truly consider yourself a genius, I believe you should be able to sufficiently prove that capability under any circumstance.”

“Well… I don't particularly think of myself as a massive genius, buuut…”

Right then.

“Ah, yes, so anyway—”

This crazy reporter guy cut me off. How impudent. I instantly developed a prejudice against this reporter.

“I would like to ask a question regarding another neurosurgery case that can prove your capabilities. Would that be alright?”

I nodded at his words. It wasn't like a different case would change much anyway. The ghosts would look at it and answer just the same.

He waddled over to the staff member managing the laptop near the projector and began displaying something on the screen.

“Yes, I would appreciate it if you could look toward the screen, Teacher Han Hyeonjae.”

At his prompt, I turned toward the screen.

“This is a patient who presented to the Emergency Room with a chief complaint of a typical thunderclap headache. You can see the non-contrast CT displayed here.”

I looked at the CT scan. An intraventricular hemorrhage that had developed in the right lateral ventricle was clearly visible.

“The CT shows an intraventricular hemorrhage, and the DSA results revealed a saccular aneurysm located at the distal portion of the medial lenticulostriate artery arising from the M1 segment of the right middle cerebral artery.”

Beep-

Then the screen switched back to the DSA.

“Based on the international guidelines for the treatment of ruptured aneurysms, please explain what surgical technique is required to prevent rebleeding.”

‘…Hmm.’

From what I had studied with the ghosts, that was an intraventricular hemorrhage. And if a ruptured saccular aneurysm is identified as the cause triggering an intraventricular hemorrhage, the aneurysm must be eliminated without delay via coil embolization or clipping…

‘But something feels off.’

[Comments]

Korean Slave 1 (Male): (Picture) (Picture) (Picture)

With that, I transmitted the non-contrast CT and DSA screens to the Gallery.

And…

[Comments]

PopOpenTheHead: Wow, look at this guy.

PopOpenTheHead: What a vicious bastard.

Mes of the God (Male): ?? What is it?

PopOpenTheHead: Ghost aneurysm sign.

PopOpenTheHead: That's a pseudoaneurysm.

‘…A pseudoaneurysm?’

A false wall created when a micro-artery completely ruptures, and the leaked blood gets temporarily trapped after being bound together by the surrounding brain parenchyma and clotted thrombus tissue. If one were to push a coil inside following the textbook method…

‘It will rupture instantly.’

And the patient would die on the table.

I stared at the reporter who had thrown this question and opened my mouth.

“Yes, Reporter.”

“Yes, Teacher.”

“I will give you my answer.”

At my words, the reporter swallowed hard.

“Since the radiological morphology of the aneurysm takes the form of a textbook saccular berry structure, the immediate surgical plan will be finalized as coil embolization.”

The moment those words came out, a smile spread across the reporter's face.

This bastard. Caught you red-handed.

“…Is the answer you were desperately hoping for in your heart.”

The reporter froze instantly.

“Am I wrong?”