Glioma

Gliomas vakadenha ma neurosurgeon kubvira kutanga kwema1900 nekuda kwekuoma kwavo uye kwakasiyana siyana kwema molecular maitiro. Ndiwo anonyanya kuzivikanwa mamota ehuropi, anobva kumasero eglial (astrocytes, oligodendrocytes uye ependymal masero) muuropi nemuzongoza. Mamota anotsanangurwa zvichienderana nesero rekwakabva, iro Astrocytomas, Oligodendrogliomas uye Ependymomas zvichiteerana. Oligodendrogliomas ine mhedzisiro iri nani pane mamwe maviri.

Gliomas akaiswa giredhi 1-4 zvichibva pane yavo histological uye mamorekuru maficha, sezvakakurudzirwa neazvino WHO classification. Kufambira mberi mumunda weuropathology kwakaita basa rakakosha mukusimudzira kunzwisisa, kuongororwa, uye kurapwa kwegliomas. Kubuda kwemamolecular profiling kwashandura manzwisisiro atinoita gliomas, zvichiita kuti kuve kwakajeka kurongeka uye nzira dzekurapa dzemunhu. Mabundu eGrade 1 ane fungidziro yakanakisa asi giredhi 4 rine fungidziro shoma.

Varwere vane gliomas vanowanzova nemamwe kana ese ematambudziko anotevera:

•  Epileptic inokwana
•  Musoro wemusoro - musoro uchangotanga kana kuchinja kwehutano hwemusoro wenguva refu
•  Chiratidzo chakasvibiswa
•  Kunetseka pakutaura kana kunzwisisa
•  Kuderedzwa ndangariro kana shanduko muhunhu
•  Kushaya simba kana kusakwana kwemaoko kana makumbo
•  Kukurova

Usati watanga kuvhiya glioma, kuongororwa kwakanaka kwakakosha. Izvi zvinosanganisira nhoroondo yakadzama uye kuongorora kusanganisira kuongorora mamiriro ekushanda. Tevere, iyo Neuroradiologist inoita yakadzama yeuropi MRI iyo inosanganisira zvidzidzo zvakaita sePerfusion, Spectroscopy, Tractography uye inoshanda MRI kuongorora gliomas nemazvo uye kupa ruzivo rwakakosha kune neurosurgeon maitiro ekuita kuvhiya zvakachengeteka.

Kuvhiyiwa inhanho yekutanga mukutarisira gliomas, kunyanya kubvisa bundu rakawanda sezvinobvira izvo zvakachengeteka uye kuwana matishu ehistopathological Kumamota eGiredhi 1 kubviswa kwakazara kwebundu ndiko kurapwa kwesarudzo pese pazvinogoneka. Kwemamota egiredhi 2-4, kuvhiyiwa kunoteverwa nemwaranzi uye chemotherapy.

Mune mamwe ma gliomas akadzika, kana mamiriro emurwere asina kunaka, stereotactic biopsy chete inoitwa kuti iwane chidimbu chetishu kuti uwane histological diagnosis. Kuvhiya kweMukai kunoitwa kana mapundu ari mukati kana kumativi akakosha anodzora mutauro, kufamba kwemaoko nemakumbo uye kuona. Neuronavigation inobatsira mukutsvaga bundu uye zvikamu zvakakosha zvehuropi nemazvo uye intraoperative ultrasound inobatsira chiremba anovhiya kubvisa bundu rakawanda asi akachengeteka panguva imwe chete.

Kunze kwemaitiro emicrosurgical uye intraoperative neurophysiological monitoring, imwe budiriro mune neurosurgery, iko kushandiswa kweiyo intraoperative fluorescence kutungamira kweglioma resection. Iyi nzira yakavakirwa pakudyidzana pakati pefluorescent agents uye glioma masero kuti awedzere kutariswa kwebundu rakakura panguva yekuvhiyiwa. 5-aminolevulinic acid (5-ALA) painotungamirirwa nemuromo kumurwere asati avhiyiwa, inosarudzwa inotorwa nemasero emarara uye metabolized inotungamirira mukugadzirwa kweprotoporphyrins inonzi fluorescent. Izvi zvinoita kuti vaonekwe uye vasiyaniswe kubva kuhuropi hwemazuva ese mushure mekushandisa mamwe mafirita akabatanidzwa kune inoshanda maikorosikopu.

Iko kubatanidzwa kweiyo fluorescence kutungamira mukuvhiya kweglioma kune akawanda mabhenefiti:

• Glioma tishu inova yakasarudzika kubva kuhuropi hwemazuva ese ichibatsira neurosurgeon kunyatsoona miganho yebundu uye kudzivirira nekusaziva kusiya bundu.
• Kuwana maximal safe resection
• Inopa mhinduro chaiyo-nguva
• Kupona kwakavandudzwa

Iyo yechishanu uye yazvino edition yeWHO kupatsanurwa kwegliomas, inomiririra shanduko yeparadigm mukuongororwa kwemamota aya, inosanganisa mamolecular maitiro mune histological maitiro.

• Kubatanidzwa kwemamorekuru anocherekedza: Iyo yazvino kupatsanurwa inoisa kusimbisa kune mamorekuru mamaki senge isocitrate dehydrogenase (IDH) gene mutations, 1p/19q co-deletion, uye MGMT promotor methylation. Aya mamakisi anoita basa mukuongororwa kwechokwadi, kufanotaura kwemhedzisiro uye kutungamira sarudzo yekurapa.
• 1p/19q co-deletion inowanzoonekwa mune oligodendrogliomas uye inofanotaura mhinduro yakanaka pakurapwa.
• IDH-mutant neIDH-wildtype zvikwata: Kuiswa kwacho kwave kusiyanisa pakati peIDH-mutant neIDH-wildtype gliomas, apo ekupedzisira ave kunzi glioblastomas zvisinei nezvimwe zvinhu.
• H3K27M shanduko: yakajairika mukupararira midline gliomas, shanduko iyi inowanzopa fungidziro yakaipa muzviitiko zvevana.

Chikwata chedu cheurosurgical chinodyidzana zvakanyanya neradiation uye zvekurapa oncologists, kuenda kumusangano we tumor board kaviri pasvondo. Chirongwa chakakodzera chekurapa chinoshandiswa uchishandisa yazvino mitsara yekuronga kuti ive nechokwadi chemhedzisiro yevarwere vedu
Tsvagiridzo inoenderera ichiburitsa shanduko nyowani dzemamorekuru zvichireva kuti chaiyo yakanangwa kurapa inogona kuwanikwa mune ramangwana inozoshandura mhedzisiro mumagliomas.
Hupenyu hwese kutevera kwevarwere veglioma inhanho yakakosha uye yakakosha mukutarisira. Varwere ava vanozoitwa MRI nguva nenguva kuti vaone kutonga kwechirwere.

Kuti udzidze zvakawanda nezvevakuru gliomas svika kune timu yedu ine ruzivo kuApollo Proton Cancer Center