While our brain perceives whatever option we choose is the best for the patient , in reality it is rarely true !
The only comment I wish to make, there is nothing called standard guidelines for complex and unusual problems .We need not be obsessed with protocols !
Please remember , If you apply standard guidelines in non-standard situations 9/10 times we are going to err !
So my choice would be, to go with your gut feeling , of course your gut should be alive , up to date and periodically maintained !
If you don’t have the guts . . . don’t worry you have plenty of other options !