Deep Brain Stimulation: Maitiro uye Benefits

tsananguro

Deep brain stimulation (DBS) inonzi neuromodulation therapy. Zvinosanganisira kudyara maelectrodes chaizvo mukati medzimwe nzvimbo dzakadzika dzehuropi, uye kuendesa mapurusi emagetsi anogadzirwa neakaiswa pulse jenareta. Aya magetsi emagetsi anoshandura kushanda kwemagetsi munzvimbo idzodzo, kuti abudise zvaanoda. Iyo pulse parameters inogona kugadziriswa uchishandisa yekunze programmer. Migumisiro yacho inogara kwenguva refu kupfuura kurapwa kwechiremba.


Iyo inzira yemhando dzakasiyana-siyana, iyo inosanganisira neurosurgeon yakadzidziswa DBS, nyanzvi yekufamba kusagadzikana neurologist, neurophysiologist, neuropsychologist, neuropsychiatrist uye neurotechnician.

Zvimwe zviratidzo zvinowanzoonekwa ndezvi

• Chirwere chePalinson
• Kudengenyeka kwakakosha
• Dystonia
• Kucherekedza kusagadzikana kusagadzikana
• Kuora mwoyo kukuru
• Tourette's syndrome
• Kurapa refractory pfari

Sei zvichiitwa

Kubva pari zvino, DBS inotenderwa neFDA kuti ishandiswe muchirwere cheParkinson, Tourette's syndrome, Essential kudedera, Dystonias uye Epilepsy. Asi, kune mhedzisiro inovimbisa pasi rese uye iri kuwedzera kushandiswa muzvirwere zvakawanda zvepfungwa seOCD, Kushungurudzika uye kupindwa muropa. Kunyangwe chirwere chetsinga senge Alzheimer chinopindura kusvika pamwero. Zvirwere izvi zvinotanga kurapwa nemishonga. Asi, kana mishonga ikakundikana kana kusashanda zvakakwana, DBS inouya kuzochengetedza zuva!

DBS kuvhiya kwakati chengetekei. Asi, sekuvhiyiwa kwese, matambudziko anogona kuitika, kungave nekuda kwekuvhiyiwa kana nekuda kwemhedzisiro yekukurudzira.

Zvinoitwa sei?

Maburi madiki ekuboorera anogadzirwa mudehenya, uye maelectrode anoiswa mukati chaimo munzvimbo dzakadzika dzehuropi, achishandisa advanced stereotactic muchina uye komputa inobatsira Neuronavigation. Ipapo waya dzekubatanidza dzinotungidzirwa kubva kumusoro kuenda pachifuva kuburikidza nemutsipa, uye dzakabatanidzwa nebhatiri rinoiswa muchipfuva.

Munguva yakawanda yemaitiro aya, murwere anonyatsomuka, kuitira kuti mhedzisiro yekukurudzira inogona kuongororwa nguva chaiyo. Murwere anochengetedzwa akanyatsogadzikana panguva yekuitwa, nenzira yepamusoro sedation matekiniki, optimal positioning, kuchengetedza tembiricha yekamuri yekuvhiya ichidziya, kutarisira kukwana kwakakwana uye panguva yakakodzera yenzvimbo yeanesthetic infiltration, uye kazhinji kuita banter inodziya nemurwere akamuka. Kazhinji kazhinji, tinonyora basa remagetsi rechinangwa, kusimbisa nzvimbo yayo. Zvadaro, isu tinomutsawo nzvimbo idzo tichishandisa maelectrode enguva pfupi kuongorora mhedzisiro yekiriniki yekukurudzira uku, pazvinhu zvakaita sekudedera uye kusimba. Zvose izvi zvinoitwa kuti zvive nechokwadi chepamusoro-soro yekuiswa, pa-sub-millimeter level.

Njodzi:Dzimwe dzenjodzi dzekuvhiya dzinosanganisira kusaiswa kwe lead, kubuda ropa parutivi rwe electrode turakiti, pfari uye kutapukirwa. Njodzi dzeanesthetic dzinosanganisirwawo senjodzi dzekuvhiya, uye izvi zvinosanganisira kuda kurutsa, nyaya dzekufema uye matambudziko emoyo. Zvinogoneka mhedzisiro yekukurudzira zvinosanganisira kuona kaviri, nyaya dzekutaura, kurira kwekunzwa, kusimba kwetsandanyama kana kuenderera mberi kwekuchinja kwemaitiro. Kazhinji njodzi idzi dzinenge shoma muvarwere vakasvinura.

Chishandiso chinobatidzwa uye kukurudzira kunotanga kazhinji mushure memavhiki maviri kubva pakuvhiyiwa. Nzira yekutsvaga yakanakisa yekukurudzira parameter, uchifunga nezvemhedzisiro uye mhedzisiro yekukurudzira, inonetsa uye chiremba wako wekutanga, kazhinji akadzidziswa neurologist, achabatanidzwa zvakanyanya.

Maitiro asati aenda kunovhiyiwa DBS

Stage 1: Kana chirwere chinogona kudzoreka cheDBS chikaonekwa, chicharamba chichitarisirwa nemishonga. Nekudaro, kana mhinduro yacho isina kukwana kana kana mhedzisiro yekurapa yakakwira, ipapo DBS inotariswa. Panguva ino chiremba wetsinga kana chiremba wepfungwa angangotaura kune nyanzvi yeurosurgeon yakadzidziswa muDBS. Special imaging yeuropi ingangodiwa. Kana zvichidikanwa kuongororwa kwepfungwa uye kwepfungwa kunoitwa zvakare.
Stage 2: Chikwata chemarudzi akawanda chinosanganisira DBS neurologist, anoshanda & stereotactic akadzidziswa neurosurgeon, neuropsychologist, neurophysiologist, neuroanesthetist, neuroradiologist, nyanzvi yemishonga yenyukireya (mune dzimwe nguva, kana radionuclide scans inoshandiswa) uye neurotechnician, vaizokurukura nyaya yacho zvakadzama. , kusvika paconcordance. Iko kuona kana DBS yakakodzera, yakachengeteka uye inogoneka kumurwere. Kunyangwe kumisikidza kuongororwa, akasiyana ekufungidzira maitiro seMRI kana SPECT angangodiwa, pamwe nematambudziko ekurapa.
Stage 3:Zvadaro, murwere nevatarisiri vavo vanotsanangurwa zvakanakira nekuipira kwekuvhiyiwa zvakadzama. Mvumo ine ruzivo inobva yatorwa. A pre-anesthetic medical work up inoitwa zvakare.

DBS kuvhiyiwa: zvatinoita pazuva rekuvhiyiwa

Kuvhiyiwa kunoitwa muzvikamu zviviri, pazuva rimwe chete. Chikamu cheuropi uye chikamu chechipfuva.

Chikamu chehuropi: Pazuva rekuvhiyiwa, murwere anoendeswa muimba yekuvhiya. Mushonga wekutindivadza wepanzvimbo ungadai wakazora ingangoita awa imwe yapfuura paganda remusoro. Musoro wepamusoro weanesthesia wakakwana unowanikwa neanodzidzira anesthetist uyo "anovhara" tsinga nhanhatu dzose dzinopa ganda remusoro. Pasi pekunyorovesa sedation, yakakosha musoro furemu (Stereotactic frame) inogadziriswa pamusoro. Izvi zvicharamba zviripo kusvika pakupera kwemaitiro. Nechimiro chiri panzvimbo, MRI kana CT scan inoitwa. Zvadaro, chinangwa che electrode uye nzvimbo dzekupinda dzicharongwa zvichienderana nemufananidzo uyu, uye maererano nechimiro.


Ipapo murwere anochinjirwa kuoperation theatre.

Brain chikamu : Muzviitiko zvakawanda ma electrode anozoiswa iwe wakasvinura uye wakangwarira. Mushonga wekutindivadza kana kuti nerve block uchavenza ganda remusoro wako nebhonzo pakuvhiyiwa. Izvi ndezvechokwadi kuti mhedzisiro yekukurudzira inogona kuedzwa zvizere. Zvisinei, mune dzimwe nguva, kuvhiyiwa kunogona kuitwa pasi peanesthesia.

Iyo trajectory inoverengerwa uchishandisa advanced computation. Zvimwe zviridzwa zvinogadziriswa pamapuranga, kunyange sezvo musoro wemurwere wakagadzirirwa patafura yekushanda. kuitira kuvhiyiwa chaiko. Uchishandisa pre-yakaverengerwa kurongeka, iwo emagetsi uye akaiswa muzvinangwa. Izvi zvisati zvaitika, micro-electrodes inoiswa munzvimbo imwechete kuti inyore zviratidzo zvemagetsi. Zvadaro, chinangwa chinokurudzirwa kuti chiongorore migumisiro nemigumisiro, neurologist, neurosurgeon uye dzimwe nguva nekutaura pathologist. Zvichienderana neizvi, chinzvimbo chacho chine micromanipulated kupa yakanakisa kiriniki maitiro. Ma electrode akavharwa panzvimbo. Mitambo yekubatanidza inochengetwa pasi peganda uye yakavharwa. Kazhinji, post operative CT scan inoitwa nefuremu, kusimbisa nzvimbo ye electrode.

Mune dzimwe nzvimbo nemamiriro ezvinhu, vakaisa zvakananga pasi peanesthesia,
• Chest wall part: Chikamu chechipiri, kazhinji pasi peanesthesia, chinosanganisira kugadzira homwe yeganda pazasi pecollar bone, nekuisa bhatiri (implantable pulse generator- IPG), pazasi pecollar bone. Izvi zvinogona kuitwa kana pasina kubvisa furemu. Iyo scalp inobatanidza waya dzakaturikidzana kugomba rechipfuva, uye dzakabatana nebhatiri.

Mushure mekushanda, murwere anogara muICU husiku hwose. Mishonga yake yenguva dzose inotangwazve. Kazhinji, kukurudzira hakuna kutanga, kwemavhiki maviri mushure mekuvhiyiwa.

Mushure mekuita

Kazhinji mushure memavhiki maviri, sutures inobviswa. Nyanzvi yekufamba kwechirwere, inoronga pulse jenareta mukiriniki yevarwere. Ikozvino kune maelectrode epamberi, tichishandisa ayo isu tinogona kutotungamira kutungamira kwekutumirwa kwazvino. Mamwe mamiriro akaita sechirwere cheParkinson kana kudengenyeka kwakakosha, zvichava nemhedzisiro inooneka. Mamwe mamiriro akaita seOCD kana dystonia, haazoratidzi kukurumidza "pa" maitiro, asi anozoratidza chete mushure memwedzi 3-6. Zvikamu zvakawanda zvekugadzirisa zvakare hurongwa zvinogona kudiwa kuti usvike pazvakanyanya kusimudzira paramita uye izvi zvinogona kutora nguva yakareba semwedzi mitanhatu. Varwere vanowanzopihwa mudziyo uri nyore wavanokwanisa kushandura kana kudzima midziyo yavo, uye kugadzirisa magetsi mumagetsi ega ega. Yakadzika ma paramita uye kuidzima paisingadiwi (sepakati pehusiku), inorebesa hupenyu hwebhatiri kusvika pamwero mukuru.

Bhatiri uye kutsiva: Hupenyu hwebhatiri hunoenderana nekushandiswa. Kune mabhatiri anochajwa zvakare ane hupenyu hurefu (kazhinji 15years), asi anotofanira kuchaja awa imwe chete mavhiki maviri ega ega nemudziyo wekunze. Iwo mabhatiri asingachajike anowanzogara 6-7years. Nguva pfupi isati yapera hupenyu hwebhatiri, inotsiviwa. Munguva iyi, ronda rechipfuva chete rinovhurwa zvakare uye zviri nyore. Ikozvino kune mabhatiri epamberi, anogona zvakare kunzwa masaisai ehuropi, uye kupa chiremba wechirongwa chikafu chekugonesa chirongwa chirinani.

Results

DBS yakachengeteka uye inoshanda chaizvo kuvhiya iyo yakabatsira mamirioni avanhu pasi rese. Kunyangwe ichirapa chirwere ichi, inodzora zvakanyanya zviratidzo zvayo zvinopedza simba. Izvi zvinopa hutano hukuru hwehupenyu, muchikamu chinobudirira chehupenyu. Uyezve, mhedzisiro yeDBS inovandudza nekufamba kwenguva uye inogara zviri nyore kupfuura 20years.