Ukukhuthazwa Kobuchopho Okujulile: Inqubo Nezinzuzo

Uhlolojikelele

I-Deep brain stimulation (DBS) iwukwelapha nge-neuromodulation. Kuhilela ukufaka ama-electrode ngokuqondile ezindaweni ezithile ezijulile zobuchopho, nokuletha ama-pulses kagesi akhiqizwa i-pulse generator efakwe. Lawa ma-pulses kagesi aguqula ukusebenza kukagesi kulezo zindawo, ukukhiqiza umphumela oyifunayo. Amapharamitha we-pulse angalungiswa kusetshenziswa umhleli wangaphandle. Imiphumela ihlala isikhathi eside kakhulu kunokwelashwa.


Kuyinqubo ehlanganisa imikhakha eminingi, ehlanganisa udokotela ohlinzayo oqeqeshelwe i-DBS, isazi sezinzwa zokunyakaza, i-neurophysiologist, i-neuropsychologist, i-neuropsychiatrist kanye ne-neurotechnician.

Ezinye izinkomba ezivame kakhulu

• Isifo sikaParkinson
• Ukundindizela okubalulekile
• I-Dystonia
• Ukuphazamiseka kokucindezela okubonakalayo
• Ukucindezeleka okukhulu
• Isifo sikaTourette
• Isithuthwane esinqandekile ngokwezempilo

Kungani kwenziwa

Kusukela manje, i-DBS ivunyelwe yi-FDA ukuthi isetshenziswe ku-Parkinson's disease, i-Tourette's syndrome, ukuthuthumela okubalulekile, i-Dystonias kanye nesifo sokuwa. Kodwa, kunemiphumela ethembisayo emhlabeni wonke futhi isetshenziswa ngokwandayo ezifweni eziningi zengqondo njenge-OCD, Ukucindezeleka kanye nokulutha. Ngisho nezifo zezinzwa ezifana ne-Alzheimer's zisabela ngezinga elithile. Lezi zifo ziqale ziphathwe ngemithi. Kodwa, uma imithi ihluleka noma ingasebenzi ngendlela efanele, i-DBS ifika izosindisa usuku!

I-DBS iwukuhlinzwa okuphephile uma kuqhathaniswa. Kodwa, njengakho konke ukuhlinzwa, izinkinga zingenzeka, noma ngenxa yokuhlinzwa noma ngenxa yemiphumela emibi yokuvuselela.

Kwenziwa kanjani?

Izimbobo zokubhoboza ezincane zenziwa ogebhezini, futhi ama-electrode abekwe kahle ezindaweni ezijulile zobuchopho, kusetshenziswa imishini ethuthukisiwe ye-stereotactic kanye ne-Neuronavigation esekelwa ikhompuyutha. Khona-ke izintambo ezixhumayo zixhunywe kusukela ekhanda kuye esifubeni ngentamo, futhi zixhunywe ebhethri elifakwe esifubeni.

Phakathi kweziningi zalezi zinqubo, isiguli siphaphame ngokugcwele, ukuze umphumela wokugqugquzela uhlolwe ngesikhathi sangempela. Isiguli sigcinwa sikhululekile phakathi nenqubo, ngezindlela ezithuthukisiwe zokulalisa, ukubeka indawo efanele, ukugcina izinga lokushisa legumbi lokusebenza lifudumele, ukunakekelwa kokungenwa kwendawo yokubulala izinzwa okwanele futhi okufika ngesikhathi, futhi ngokuvamile uhlanganyela e-banter efudumele nesiguli esiphapheme. Ngokuvamile, siqopha umsebenzi kagesi wethagethi, ukuze siqinisekise indawo yayo. Bese, siphinde sikhuthaze lezo zindawo sisebenzisa ama-electrode esikhashana ukuze sihlole umphumela womtholampilo walokhu kushukumisa, ezicini ezifana nokundindizela kanye nokuqina. Konke lokhu kwenzelwa ukuqinisekisa ukunemba okuphezulu kokubekwa, ezingeni le-sub-millimeter.

Izingozi :Ezinye zezingozi zokuhlinzwa zihlanganisa ukuduka komthofu, ukopha eduze kwepheshana lama-electrode, ukuquleka kanye nokutheleleka. Izingozi zokubulala izinzwa nazo zifakiwe njengezingozi zokuhlinzwa, futhi lezi zihlanganisa isicanucanu, izinkinga zokuphefumula nezinkinga zenhliziyo. Imiphumela engemihle engaba khona yokuvuselela ihlanganisa ukubona kabili, izinkinga zenkulumo, ukuzwa okugedla, ukuqina kwemisipha noma ukushintsha kwesimo senhliziyo. Ngokuvamile lezi zingozi zincane kakhulu ezigulini eziphapheme.

Idivayisi ivuliwe futhi ukuvuselela kuqala ngokuvamile ngemva kwamasonto amabili kusukela kokuhlinzwa. Inqubo yokuthola ipharamitha yokuvuselela engcono kakhulu, kucatshangelwa imiphumela kanye nemiphumela emibi yokuvuselela, iyinselele futhi udokotela wakho oyinhloko, ngokuvamile oyisazi sezinzwa eziqeqeshiwe, uzohileleka ngokujulile.

Inqubo ngaphambi kokuya kukuhlinzwa kwe-DBS

Isiteji 1: Uma isifo esingalawuleka se-DBS sitholwa, sisazophathwa ngezokwelapha. Kodwa-ke, uma impendulo inganele noma uma imiphumela emibi yezokwelapha iphezulu, kuzobhekwa i-DBS. Kuleli qophelo udokotela wezinzwa noma udokotela wengqondo uzobhekisela kudokotela ohlinzayo wezinzwa oqeqeshiwe e-DBS. Ukuthwebula kwengqondo okukhethekile kungase kudingeke. Uma kunesidingo kuyenziwa ukuhlolwa kwengqondo nokwengqondo.
Isiteji 2: Ithimba lezinhlaka eziningi elihlanganisa udokotela wezinzwa we-DBS, udokotela ohlinzayo wezinzwa osebenzayo & stereotactic oqeqeshwe nge-neuropsychologist, i-neurophysiologist, i-neuroanesthetist, i-neuroradiologist, uchwepheshe wemithi yenuzi (kwezinye izimo, lapho kusetshenziswa izikena ze-radionuclide) kanye ne-neurotechnician, bazoxoxa ngecala ngokuningiliziwe. , ukufika kukhonkodensi. Iwukunquma ukuthi i-DBS ifanelekile yini, iphephile futhi ingenzeka esigulini. Ngisho nokuthola ukuxilongwa, izindlela ezihlukahlukene zokucabanga njenge-MRI noma i-SPECT zingadingeka, kanye nezinselele zokwelapha.
Isiteji 3:Khona-ke, isiguli nabanakekeli baso bachazwa ngokuningiliziwe ubuhle nobubi bokuhlinzwa. Kube sekuthathwa imvume enolwazi. Umsebenzi wezokwelapha wangaphambi kokubulala izinzwa nawo uyenziwa.

Ukuhlinzwa kwe-DBS: esikwenzayo ngosuku lokuhlinzwa

Ukuhlinzwa kwenziwa ngezigaba ezimbili, ngosuku olulodwa. Ingxenye yobuchopho kanye nengxenye yesifuba.

Ingxenye yobuchopho: Ngosuku lokuhlinzwa, isiguli siyiswa egumbini lokuhlinzwa. Ukhilimu wendawo obulala izinzwa ubungase ugcobe okungenani ihora elilodwa ngaphambili ekhanda. I-anesthesia ye-scalp ephelele itholwa udokotela obulala izinzwa oqeqeshiwe "ovimba" yonke imizwa eyisithupha ehlinzeka ngekhanda. Ngaphansi kwe-sedation emnene, uhlaka lwekhanda olukhethekile (uhlaka lwe-Stereotactic) lugxilile ekhanda. Lokhu kuzohlala kuze kube sekupheleni kwenqubo. Ngohlaka endaweni, i-MRI noma i-CT scan yenziwa. Khona-ke, i-electrode target kanye namaphuzu okungena azohlelwa ngokusekelwe kulesi sithombe, futhi ngokuphathelene nohlaka.


Bese isiguli sishintshelwa endaweni yemidlalo yaseshashalazini.

Ingxenye yobuchopho : Ezimweni eziningi ama-electrode azobekwa ngesikhathi uphapheme futhi uqaphile. Umuthi obulala izinzwa wendawo noma i-nerve block izothuntubeza isikhumba sakho sekhanda nethambo ngesikhathi sokuhlinzwa. Lokhu kuqinisekisa ukuthi imiphumela yokuvuselela ingahlolwa ngokugcwele. Nokho, kwezinye izimo, ukuhlinzwa kungenziwa ngaphansi kwe-anesthesia jikelele.

I-trajectory ibalwa kusetshenziswa ukubala okuthuthukisiwe. Ezinye izinsimbi zigxilwa ohlakeni, njengoba nje nekhanda lesiguli ligxiliswe etafuleni lokuhlinza. ngokuhlinzwa okufanele. Ngokusebenzisa izixhumanisi ezibalwe ngaphambilini, ama-electrode futhi abekwe ezihlosweni. Ngaphambi kwalokhu, ama-micro-electrodes afakwa endaweni efanayo ukuze aqophe amasignali kagesi. Khona-ke, okuhlosiwe kuyakhuthazwa ukuba kuhlolwe imiphumela kanye nemiphumela emibi, yi-neurologist, neurosurgeon futhi ngezinye izikhathi nge-pathologist yokukhuluma. Kuye ngalokhu, isikhundla siqhutshwa kancane ukuze sinikeze umphumela omuhle kakhulu womtholampilo. Ama-electrode avaliwe endaweni. Izintambo zokuxhuma zigcinwa ngaphansi kwesikhumba futhi zivaliwe. Ngokuvamile, i-post operative CT scan yenziwa ngohlaka, ukuze kuqinisekiswe indawo yama-electrode.

Ezindaweni ezithile nezimo, babekwa ngqo ngaphansi kwe-anesthesia jikelele,
• Ingxenye yodonga lwesifuba: Ingxenye yesibili, ngokuvamile ngaphansi kwe-anesthesia jikelele, ihlanganisa ukwenza isikhwama sesikhumba ngaphansi kwethambo lekhololo, nokubeka ibhethri( i-implantable pulse generator- IPG), ngezansi nje kwethambo lekholomu. Lokhu kungenziwa ngokukhipha noma ngaphandle kokukhipha ifremu. Izintambo ezixhuma esikhunjeni sekhanda zihunyushelwa endaweni yesifuba, futhi zixhunywe ebhethrini.

Ngemuva kokuhlinzwa, isiguli sizohlala e-ICU ubusuku bonke. Imithi yakhe evamile iyaqalwa kabusha. Ngokuvamile, ukukhuthazwa AKUQALIWE, okungenani amasonto amabili ngemva kokuhlinzwa.

Ngemuva kwenqubo

Ngokuvamile ngemva kwamasonto amabili, ama-sutures ayasuswa. Uchwepheshe wezifo zokunyakaza, uhlela i-pulse generator emtholampilo wesiguli. Manje sekunama-electrode athuthukile, esingawasebenzisa ngisho nokuqondisa indlela yokulethwa kwamanje. Ezinye izimo ezifana nesifo sikaParkinson noma ukundindizela okubalulekile, kuzoba nemiphumela ebonakalayo ngokushesha. Ezinye izimo ezifana ne-OCD noma i-dystonia, ngeke zibonise umphumela "woku" osheshayo, kodwa zizobonisa kuphela ngemva kwezinyanga ezingu-3-6. Amaseshini amaningi okuhlelwa kabusha angase adingeke ukuze kufike kumapharamitha angcono kakhulu wokuvuselela futhi lokhu kungase kuthathe isikhathi esingangezinyanga eziyisithupha. Iziguli zivame ukunikwa umshini olula ezingavula noma zivale ngawo amadivaysi azo, futhi zilungise ugesi ku-electrode ngayinye . Nciphisa amapharamitha bese uyicisha uma ingadingeki (njengasebusuku), izokwelula impilo yebhethri ngokwezinga elikhulu.

Ibhethri nokushintshwa: Impilo yebhethri incike ekusetshenzisweni. Kunamabhethri aphinde ashajwa aphila isikhathi eside (imvamisa engu-15years), kodwa adinga ukushajwa ihora elilodwa njalo emavikini amabili ngocingo lwangaphandle. Amabhethri angaphinde ashajwe ahlala iminyaka engu-6-7. Ngaphambi nje kokuphela kwempilo yebhethri, iyashintshwa. Phakathi nale nqubo, inxeba lesifuba kuphela elivulwa kabusha futhi lilula. Manje sekunamabhethri athuthukisiwe, angakwazi futhi ukuzwa amaza obuchopho, futhi anikeze udokotela ohlelayo impendulo ukuze anike amandla ukuhlela okungcono.

Imiphumela

I-DBS iwukuhlinzwa okuphephile futhi okusebenza ngempumelelo osekusize izigidi zabantu emhlabeni jikelele. Nakuba iselapha lesi sifo, ilawula ngokuphawulekayo izimpawu zayo eziqeda amandla. Lokhu kunikeza izinga eliphezulu lempilo, esigabeni esikhiqiza kakhulu sempilo. Ngaphezu kwalokho, umphumela we-DBS uyathuthuka ngokuhamba kwesikhathi futhi uhlala kalula ngaphezu kweminyaka engama-20.