Glioma

Gliomas tau tawm tsam cov kws kho mob neurosurgeons txij thaum xyoo 1900s vim lawv cov yam ntxwv sib txawv thiab txawv txav. Lawv yog cov kab mob loj tshaj plaws hauv lub hlwb, pib los ntawm cov hlwb glial (astrocytes, oligodendrocytes thiab ependymal hlwb) hauv lub hlwb thiab qaum qaum. Cov qog tau piav qhia raws li lub hauv paus chiv keeb ntawm lub cell, uas yog, Astrocytomas, Oligodendrogliomas thiab Ependymomas feem. Oligodendrogliomas muaj txiaj ntsig zoo dua li ob qho tib si.

Gliomas tau qhab nia 1-4 raws li lawv cov keeb kwm thiab cov qauv molecular, raws li kev pom zoo los ntawm WHO qhov kev faib tawm tshiab. Kev nce qib hauv thaj tsam ntawm neuropathology tau ua lub luag haujlwm tseem ceeb hauv kev txhim kho kev nkag siab, kev kuaj mob, thiab kev kho mob ntawm gliomas. Qhov tshwm sim ntawm molecular profiling tau hloov pauv peb txoj kev nkag siab ntawm gliomas, ua kom muaj kev faib tawm ntau dua thiab cov tswv yim kho tus kheej. Qib 1 cov qog nqaij hlav muaj qhov zoo tshaj plaws thaum qib 4 muaj cov tsos mob tsis zoo.

Cov neeg mob uas muaj gliomas feem ntau muaj qee yam lossis tag nrho cov teeb meem hauv qab no:

•  Epileptic haum
•  Mob taub hau - qhov pib mob taub hau tsis ntev los no los yog kev hloov ntawm tus cwj pwm ntawm kev mob taub hau ntev
•  Qhov muag plooj tsis pom kev
•  Nyuaj ntawm kev hais lus lossis kev nkag siab
•  Txo kev nco lossis hloov tus cwj pwm
•  Tsis muaj zog los yog clumsiness ntawm ob txhais tes los yog ob txhais ceg
•  Tsaus ntuj

Ua ntej pib ntawm kev phais glioma, kev ntsuam xyuas zoo yog qhov tseem ceeb. Qhov no suav nrog cov keeb kwm ntxaws ntxaws thiab kev kuaj xyuas nrog rau kev ntsuas qhov ua haujlwm tau zoo. Tom ntej no, Neuroradiologist ua cov ncauj lus kom ntxaws MRI uas suav nrog cov kev tshawb fawb xws li Perfusion, Spectroscopy, Tractography thiab ua haujlwm MRI txhawm rau kuaj xyuas gliomas kom raug thiab muab cov ntaub ntawv tseem ceeb rau tus kws kho mob neurosurgeon yuav ua li cas rau kev phais kom zoo.

Kev phais yog thawj kauj ruam hauv kev tswj cov gliomas, feem ntau yog tshem tawm cov qog ntau li ntau tau uas muaj kev nyab xeeb thiab tau txais cov ntaub so ntswg rau cov qog ntshav rau Qib 1 cov qog ua tiav cov qog nqaij hlav yog kev kho mob ntawm kev xaiv thaum twg ua tau. Rau qib 2-4 qog nqaij hlav, kev phais yog ua raws li hluav taws xob thiab tshuaj tua kab mob.

Hauv qee qhov sib sib zog nqus gliomas, lossis yog tias tus neeg mob tus mob tsis zoo, ib qho stereotactic biopsy ib leeg yog ua kom tau txais cov ntaub so ntswg me me kom tau txais kev kuaj mob histological. Kev phais kom tsaug zog yog ua thaum cov qog nyob hauv lossis ib puag ncig cov chaw tseem ceeb uas tswj cov lus, txhais tes thiab txhais ceg thiab lub zeem muag. Neuronavigation pab nrhiav cov qog thiab qhov tseem ceeb ntawm lub hlwb kom raug thiab intraoperative ultrasound pab tus kws phais tshem tawm cov qog ntau dua thaum muaj kev nyab xeeb nyob rau tib lub sijhawm.

Sib nrug los ntawm cov txheej txheem microsurgical thiab intraoperative neurophysiological saib xyuas, lwm qhov kev ua haujlwm hauv neurosurgery, yog kev siv intraoperative fluorescence kev taw qhia rau glioma resection. Cov txheej txheem no yog ua raws li kev sib cuam tshuam ntawm cov tshuaj fluorescent thiab glioma hlwb txhawm rau txhim kho kev tshawb pom cov qog nqaij hlav tag nrho thaum phais. 5-aminolevulinic acid (5-ALA) thaum muab tshuaj rau qhov ncauj rau tus neeg mob ua ntej kev phais, raug xaiv los ntawm cov qog hlwb thiab metabolized ua rau tsim cov protoporphyrins uas muaj fluorescent. Qhov no ua rau lawv pom thiab paub qhov txawv ntawm lub hlwb li qub tom qab siv qee cov ntxaij lim dej txuas nrog lub tshuab ntsuas kev ua haujlwm.

Kev sib koom ua ke ntawm fluorescence kev taw qhia rau hauv kev phais glioma muaj ntau yam zoo:

• Glioma cov ntaub so ntswg ua rau pom qhov txawv ntawm lub hlwb ib txwm pab tus kws kho mob neurosurgeon kom paub meej cov npoo ntawm cov qog thiab tsis txhob ua tsis ncaj ncees lawm tom qab qog.
• Ua tiav qhov kev txiav txim siab zoo tshaj plaws
• Muab cov lus teb rau lub sijhawm tiag tiag
• Txhim kho txoj sia nyob

Qhov thib 5 thiab qhov tseeb tshaj tawm ntawm WHO kev faib tawm ntawm gliomas, sawv cev rau kev hloov pauv hauv kev kuaj mob ntawm cov qog no, suav nrog cov yam ntxwv molecular rau hauv cov txheej txheem histological.

• Kev sib koom ua ke ntawm cov cim molecular: Qhov kev faib tawm tshiab tshaj plaws qhia txog cov cim molecular xws li isocitrate dehydrogenase (IDH) gene mutations, 1p/19q co-deletion, thiab MGMT promotor methylation. Cov cim no ua lub luag haujlwm hauv kev kuaj mob kom raug, kev kwv yees ntawm qhov tshwm sim thiab coj kev txiav txim siab kho mob.
• 1p / 19q co-deletion feem ntau pom hauv oligodendrogliomas thiab kwv yees cov lus teb zoo rau kev kho mob
• IDH-mutant thiab IDH-wildtype pawg: Kev faib tawm tam sim no txawv ntawm IDH-mutant thiab IDH-wildtype gliomas, qhov tom kawg tam sim no tau muab cais ua glioblastomas tsis hais txog lwm yam nta.
• H3K27M kev hloov pauv: feem ntau nyob rau hauv diffuse midline gliomas, qhov kev hloov pauv no feem ntau ua rau pom qhov tsis zoo hauv cov menyuam yaus.

Peb pab pawg neurosurgical cuam tshuam nrog cov hluav taws xob thiab cov kws kho mob oncologist, tuaj koom lub rooj sib tham qog nqaij hlav ob zaug ib lub lim tiam. Ib txoj kev kho mob uas tsim nyog yog siv los siv cov txheej txheem kev faib tawm tshiab los xyuas kom meej tias cov txiaj ntsig zoo rau peb cov neeg mob
Kev tshawb fawb txuas ntxiv nthuav tawm cov kev hloov pauv tshiab molecular qhia tias cov kev kho tshwj xeeb yuav muaj nyob rau yav tom ntej uas yuav hloov cov txiaj ntsig hauv gliomas.
Kev soj ntsuam tas mus li ntawm cov neeg mob glioma yog ib kauj ruam tseem ceeb thiab tseem ceeb hauv kev tswj hwm. Cov neeg mob no yuav tau txais MRI ntawm ib ntus kom ntseeg tau tias muaj kab mob.

Yog xav paub ntxiv txog cov neeg laus gliomas hu rau peb pab neeg ua haujlwm ntawm Apollo Proton Cancer Center