Imisebe yomthamo oyedwa ongakwazi ukuphatha izimo ezithile zobuchopho ngaphandle kokuhlinzwa
I-Gamma i-radiosurgery yindlela yokuhlinzeka eyithuthukisiwe lapho kubonakala khona umzila ogqamile kakhulu wokushisa imisebe ukubhubhisa ngokuqondile izindawo zezicubu. Nakuba kuthiwa ukuhlinzwa, inqubo yeGamma Knife ayihileleki ukucubungula noma isithwebuli.
Le nqubo iyingcosana kakhulu kunokuhlinzwa okwejwayelekile futhi inikeza ngokunemba okukhulu lapho kwenziwa imisebenzi encane, ikakhulukazi ebuchosheni.
Ngenxa yalokhu, ukuhlinza kweGamma Knife kungenziwa njalo ngesiguli noma ngokuhlala esibhedlela ebusuku.
Umlando
I-radiosurgery e-Stereotactic yaqala ukukhululwa ngo-1949 yi-neurosurgeon yaseSweden uLars Leskell ngenhloso yokwelapha izindawo ezincane zobuchopho ngaphandle kokulimaza izicubu eziseduze.
Imiklamo yokuqala kaLeskell yedivaysi esetshenziswa i-X-ray, iproton, kanye nemigqa ye-gamma kamuva yokuletha umzila omncane wemisebe endaweni ehlosiwe ebuchosheni. Ngokuqondisa imisebe evela emazingweni amaningi, izigxobo eziguquguqukayo zingakwazi ukuletha umthamo obulalayo ukubhubhisa izicubu, ukuvimbela izinzwa, noma ukuvala imithwalo yegazi ngomonakalo obuncane wokubambisana.
U-Leskell wethula ngokusemthethweni i-Gamma Knife ngo-1968. Ngawo-1970, i-Gamma Knife yayine-stereotactic ngokugcwele (i-three-dimensional approach) ngokusungulwa kwe- imagination resonance magnetic (MRI) nokuhlolwa kwe- tomography (CT) . I-Gamma Knife yokuqala yalethwa kuphela yi-United States ngo-1979 ngelungiselelo phakathi kweLeskell neYunivesithi yaseCalifornia, eLos Angeles.
I-Gamma Knife namuhla inguphawu lokuhweba olubhalisiwe lwe-Elekta Instruments, Inc. e-Stockholm, eSweden.
Amadivaysi afanayo e-Radiosurgical
Ngaphandle kwedivayisi yamaLeskell, ithuluzi elifanayo elibizwa ngokuthi i-linear accelerator (Linac) lakhiwa ngo-1952 njengendlela yokwelashwa kwemisebe yama-fractional (multi-dose).
Kwakuphela ngo-1982 ukuthi ukulungiswa kwedivayisi kwayivumela ukuba isetshenziswe kuma-radiosurgery.
Idivaysi ye-Linac ihluke kwiGamma Knife lapho isetshenziselwa khona ukwelapha imishanguzo ezingxenyeni eziningi zomzimba. I-Gamma Knife, ngokuphambene, isetshenziselwa kuphela ukuhlinzekwa kwezidakamizwa zobuchopho. Ngaphezu kwalokho, idivayisi ye-Linac idinga ubuchwepheshe obukhulu kakhulu nobuchwepheshe uma isetshenziselwa i-radiosurgery futhi ihlinzekela ibhegi elibanzi kakhulu uma kuqhathaniswa neGamma Knife (1.1 millimeters ngokulingana no-0.15 millimeter, ngokulandelana).
Umqondo omusha obizwa ngeLinac Cyberknife wethulwa ngo-2001 futhi ngokuyinhloko ulinganisa iGamma Knife ngomqondo. Idivayisi, ifakwe engxenyeni ye-robotic, ihlinzekela imisebe ehlosiwe esuka kuma-angles amaningi kodwa, ngokungafani ne-Gamma Knife, ayizange ibonise amazinga okusinda okuthuthukisiwe uma kuqhathaniswa nezinye izinhlobo zokwelapha imishanguzo yomdlavuza.
Uhlobo lokugcina lwe-radiosurgery, olwaziwa nge- proton beam therapy (PBT) , lusebentisa umthamo wezinhlayiyana ze-proton ukuze kulungiswe izicubu ezigulayo. Kodwa-ke, isifundo se-2012 esivela ku-American Society of Radiation Oncology siphetha ngokuthi i-PBT ayizange ihlinzeke ngezinzuzo ezivamile ezinomthelela wokwelashwa kwemisebe ngaphandle kwezingane ezinganeni zomzimba zesimiso sezinzwa eziphakathi, iso le-melanoma ne- chordomas (uhlobo lomdlavuza wethambo).
Naphezu kwezinzuzo ezikhona ze-PBT, izindleko eziyingqayizivele zesistimu (phakathi kuka- $ 100 kuya ku-180 million) kwenza kube yinkinga engenakwenzeka yezibhedlela eziningi.
Izimo zenziwe
I-Gamma i-radiosurgery ijwayele ukusetshenziselwa ukuphatha izicubu nezinye izilonda ebuchosheni. Kodwa kungabuye kuphumelele ekwelapheni ubuhlungu abathile kanye nokuphazamiseka kokunyakaza kanye nokungavamile kwamasongo ebuchosheni.
I-Gamma Knife isetshenziswa ngokuyinhloko ukuphatha lezi zimo ezilandelayo:
- Ama-metastase we-Brain (amakhevuza asakaze ebuchosheni avela emzimbeni kwezinye izitho)
- I-glioblastoma (uhlobo lomdlavuza wengqondo)
- I-Acoustic neuroma (i-tumor engenangqamuzana emanzini avela endlebeni yangaphakathi kuya ebuchosheni)
- I-Meningioma (isisu esingajwayelekile esingenangqamuzana esivela emagqumeni azungeze ubuchopho nomgogodla)
- I-adenoma ye-Pituitary (isisu esingenakunqamuzana se-pituitary gland)
- Isifo sikaCushing (i-pituitary engajwayelekile lapho umzimba uveza i-hormone yokucindezeleka kakhulu, i-cortisol, ngenxa yokugulisa izicubu noma izidakamizwa ze-steroid njenge- prednisone )
- I-neuralgia ye-Trigeminal (isimo lapho ukucindezelwa khona kwezintathu ezibuthakathaka kubangela ubuhlungu obuseduze obusweni)
- Ukuthuthumela okubalulekile (ukuphazamiseka kwengqondo okubangela ukuthuthumela okungazibandakanyi futhi okunesigqi, okungahambisani nesifo sikaParkinson)
- Ukuhlukunyezwa kwe-Arteriovenous, noma i-AVM (ukuxhumeka okungavamile phakathi kwemithambo nemifino, ngokuvamile ebuchosheni noma emgodleni)
I-Gamma i-radiosurgery ingase isetshenziswe ezimweni lapho ukuhlinzwa kwengqondo okungenakufinyelelwa khona ngokuhlinzwa okujwayelekile noma kubantu abangenakubekezelela inqubo yokuhlinza evulekile njengokwenziwa kwe- craniotomy .
Ngenxa yokuthi imiphumela enenzuzo yenqubo yeGamma Knife ibonakala kancane ngokuhamba kwesikhathi, ayisetshenziselwa abantu abanesimo esidinga ukwelashwa ngokushesha noma okuphuthumayo.
Indlela Esebenza ngayo
Inqubo yeGamma Knife ibizwa ngokuthi "ukuhlinzwa" ngoba ingenziwa enkathini eyodwa ngemigomo efanayo yemitholampilo yokusebenza okuvamile. Imiphumela ye-Gamma Knife ihluke ngohlobo lwesifo esiphathwayo:
- Uma isetshenziselwa ukuphatha izicubu, imishanguzo egxilile iphazamisa i-DNA kumaseli omzimba. Lokhu kuphazamisa ikhono leseli lokuphindaphindiwe, okwenza isisu sibe sehlehlise.
- Uma isetshenziselwa ukwelapha izifo ze-neurological, i-boram of radiation ibangela ukwakheka kwesilonda esivimbela izimpawu zesisindo.
- Uma isetshenziselwa ukuphatha i-AVM, i-Gamma Knife inganciphisa usayizi nomthamo wegazi ogeleza emkhunjini, ngaleyo ndlela kuncishiswe ingozi yokuphuka noma isifo sohlangothi.
Umshini uqobo ufana nokuklama kuya kwi-MRI noma i-CT scan ngebhede eliphambene nombhede onjenge-tube okufakwa kuyo ikhanda lakho. Akusiwo ojulile njengeminye imishini, kodwa, futhi iyathule kangangokuthi awukwazi ukuzwa i-claustrophobia.
Okufanele Ukulindele
Inqubo ye-Gamma Knife ngokuvamile ihilela ithimba lezokwelapha, kuhlanganise ne-oncologist yemisebe (udokotela wesifo somdlavuza ogcizelele emisebeni), i-neurosurgeon, i-radiation therapist, nomhlengikazi obhalisiwe. Inqubo ingahluka kancane kuye ngokuthi isimo siphathwe kodwa ngokuvamile senziwa ngezinyathelo ezilandelayo:
- Uma ufika ukwelashwa, uzocelwa ukuba ulale embhedeni ophansi ngemva kwalokho okuyi-mask noma i-headweight head frame uzosetshenziselwa ukuzinzisa ikhanda lakho futhi uligcine ekuhambeni.
- Kuzobe kwenziwa i-MRI noma i-CT ukukhomba indawo ngqo kanye nobukhulu besakhiwo okuhlosiwe noma okungavamile.
- Ngokusekelwe emiphumeleni, ithimba lizohlela uhlelo lokulashwa kubandakanya inombolo ecacile yokuchayeka kanye nokubekwa kwe-beam.
- Ngemva kokuma esikhundleni, ikhanda lakho lizohanjiswa endaweni, futhi ukuphathwa kwemisebe kuzoqala. Ungabe uphapheme ngokuphelele futhi uxhumeke odokotela bakho ngokusebenzisa uxhumano lwamazwi. Kuye ngesimo, inqubo ingathatha noma yikuphi ukusuka emaminithini ambalwa kuya ngaphezulu kwehora.
Imiphumela Yokwelashwa Side Side
Ngenkathi inqubo yeGamma Knife ngokwayo ingenabuhlungu, ukusebenzisa imisebe kungase kubangele imiphumela emibi ikakhulu ngenxa yokuvuvukala kobuchopho. Ubukhulu bezimpawu buvame ukuhlotshaniswa nobude kanye nendawo yokuphathwa kwe-radiation futhi kungafaka:
- Izinwele
- Ubumbulu
- I-nausea
- Umbono ogqamile
- Ukungabi namandla
- Ukulahlekelwa ibhalansi
- Ukulahleka kwezinwele (ngokuvamile okwesikhashana)
- Ukuzizwa
Kungase kube nezinye izingozi ezihlobene nesimo sakho sezokwelapha. Qinisekisa ukuthi ukhuluma nodokotela wakho ngalokhu ngaphambi kokuba uqhubeke nenqubo yeGamma Knife.
Ukuphumelela
I-Gamma i-radiosurgery iboniswe ngempumelelo ekwelapheni izicubu ezinobuthi noma ezimbi kuze kube ngamasentimitha amane (cishe u-1½ amasentimitha) ngobukhulu. Kubantu abanesifo somdlavuza we-metastatic brain , inqubo ibonakala iyasebenza ekuhlinzekeni ukulawula isisu nokukhulisa izikhathi zokusinda.
Amazinga okuphumelela ahlukahluka ngesimo esiphathwayo, kanje:
- Ngokuqondene ne-AVM, ukubhekwa kwezidakamizwa kubhekwa njengendlela eyinhloko yokwelapha namuhla futhi kunenani lokuphulukisa eliphakathi kwama-54% namaphesenti angu-92 kuye ngokuthi indawo yomkhumbi.
- Phakathi naleso sikhathi, isifundo se-2016 esivela eYurophu sabika ukuthi abantu abane-trigeminal neuralgia bazuze kakhulu kule nqubo, kanti amaphesenti angu-71.8 ashiye ubuhlungu iminyaka emithathu kanti amaphesenti angu-45.3 asele ubuhlungu obungaphezu kuka-10.
- Ngokufanayo, ukuhlaziywa kuka-2012 kwezifundo zemitholampilo kubike ukuthi amaphesenti angu-88.3 abantu abaphathwa ngokubhebhethekisa okudingekayo kugcinwe ukulawulwa kwezimoto ezihle kakhulu emva kwezinyanga ezingu-24.
- Ucwaningo olwenziwa ngo-2013 oluvela eNyuvesi yaseVirginia School of Medicine lwabonisa ukuthi inqubo yeGamma Knife yanikeza ukulawula okungama-98 kwezidumbu ezihambisana nesifo sikaCushing isikhathi sokucwaninga kweminyaka emine.
Ukuhlukunyezwa okunzima okulandela i-Gamma Knife radiosurgery kubhekwa kungavamile, kanti iningi lihlobene nesimo esibucayi kunalokho inqubo ngokwayo.
> Imithombo:
> Ohye, C .; I-Higuchi, i-Y .; Shibazaki. T. et al. "Ummese we-Gamma we-thalamotomy wesifo sika-Parkinson nokuzamazama okubaluleke kakhulu: Ucwaningo oluthile oluthile oluthile." I-Neurosurgery. 2012; 70 (3): 526-35. I-DOI: 10.1227 / NEU.0b013e3182350893.
> Ipaki, H .; Wang, E .; Hamba, C. et al. "Ukuguqula amaphethini womkhuba weGamma Knife ngokumelene ne-radiosurgery esekelwe eline-stereotactic eline-line for metastases e-US." J Neurosurg. 2016 ; 124 (4): 1018-1024. I-DOI: 10.3171 / 2015.4.JNS1573.
> I-Plasencia, i-A. ne-Santillan, i-A. "Ukumiswa kanye nokusetshenziswa kwemisebe ye-radiosurgery yezinkinga ezingenasici." Surg Neurol Int . 2012; 3 (I-Suppl 2): S90-S104. I-DOI: 10.4103 / 2152-7806.95420.
> Regis, J .; I-Tuleasca, i-C.; Ressequier, N. et al. "Ukuphepha kwesikhathi esigcwele nokusebenza kwe-Gamma Knife ukuhlinza ngo-classical neuralgia ye-trigeminal: isifundo somlando wesiguli esineziguli ezingu-497." J Neurosurg. 2016; 124 (4): 1079-87. I-DOI: 10.3171 / 2015.2.JNS142144.
> Sheehan, J .; I-Xu, i-Z .; Salvetti, D. et al. "Imiphumela yokuhlinzwa kwe-gamma ummese weCreat's Disease." J Neurosurg. 2013; 199 (6): 468-92. I-DOI: 10.3171 / 2013.7.JNS13217.