Ukuhlinzwa ngonyama kuyinto ekhethwa ngokusetyenziswa rhoqo njengoko ubuchule buba ngcono kangangoko kwaye iziphumo ziphucula .
I-Hemispherectomy iphakathi kweendlela zokugqirha ezona zidlulileyo . Yinkqubo ebandakanya ukususa inxalenye yengqondo kunye nokunqanyulwa kweengingqi zengqondo ukuze unciphise ama-seizures. Kule minyaka edlulileyo, inkqubo iye yavela, ngokukhuseleka kokukhuselwa kunye neziphumo.
Iinkcazo
Ininzi yexesha, i-hemispherectomy isetyenziselwa abantwana abaneentlobo ezithile zokuhluthwa, kodwa abanye abadala bangazuza kwakhona kwinkqubo.
I-hemispherectomy ingathathwa njengokuba inokwenzeka ukuba unesifo sokuxhamla, oku kuthetha ukuba ukuxhamla kudla ngokukhawuleza, kunzima, kwaye akukwazi ukulawulwa ngamayeza okunyamezela.
Kwakhona ukhetho lweentlobo ezithile zokuhluthwa ngokuziwayo ukuphendula kakuhle kwi-hemispherectomy. Ezi ziqhelekileyo ziquka:
- I-encephalitis kaRasmussen : Esi sisifo esingaqhelekanga esivame ukuphumela ekuqhubekeni, kunzima ukulawula ukutshatyalaliswa. I-encephalitis kaRasmussen inokufuna unyango ngeenkqubo zokutyanda ezifana ne-hemispherectomy okanye i- corpus callosotomy.
- Inkcazo ye-Cortical: Ngezizathu ezingachazwanga, abantwana banokuzalwa ngokungahambi kakuhle kweengqondo ezingabangela ukuxhwala.
- Ulwaphulo lwamaPerinatal : I- stroke ye- Perinatal ivele ngaphambi kokuba umntwana azalwe okanye kungekudala emva koko. Oku kunokubangela iingxaki zomsebenzi wengqondo, ezifana nokutshatyalaliswa.
Iintlobo
Kukho inani leentlobo ze-hemispherectomy, kwaye iqela lakho lezonyango liya kukwenza isicwangciso esona siphumelele esekelwe kwipatheni yesithuthwane kunye nokuhlolwa kwakho kwangaphambi kokuvanywa. Iinkqubo ezahlukeneyo ze-hemispherectomy zonke zinemigangatho emininzi ngokuqhelekileyo, kubandakanywa nokususwa kweengxube zeengqondo kunye neendawo zokuhlula ngokwahlukileyo kwengqondo.
Injongo yokususa ummandla wengqondo kukuphelisa indawo okanye indawo eziye zaboniswa ukuba zibangele i-EEG yakho. Injongo yokunqumla uxhulumaniso phakathi kweendawo zengqondo kukuthintela umsebenzi owenziwe ngogesi kwindawo yengqondo ukusasazeka nokubangela ukubaleka.
Iintlobo eziqhelekileyo ze-hemispherectomy zi:
- I-Anatomic: Le nkqubo iyona hlobo olubanzi kakhulu lwe-hemipherectomy kwaye lubandakanya ukususa iindawo ezikwindawo yesobunxele okanye ilungelo lokunciphisa umsebenzi wokuthungatha. Nangona oku kubonakala kunzima kakhulu, abantu abafumana i-anatomic hemispherectomy bayakwazi ukuphila, kwaye basebenza kakuhle. Kungase kubekho ukulahlekelwa kwamakhono, nangona kunjalo, ngokukodwa kwizakhono ezinxulumene nokuhlukana kwesobunxele kunye nokuqonda kwendawo (ukukwazi ukuqonda ububanzi obuthathu nokuzibona iinxalenye zomzimba).
- Ukusebenza komdabu: Olu hlobo lwe-hemispherectomy lubandakanya ukususwa kwecandelo elincinci leengxube zengqondo ezisuka kwi-hemisphere ejongene nokubangela ukuxhatshazwa, kunye nokuhlukana kwe-corpus callosum.
- I-Peri yodwa: Le nkqubo iyancipha ngokwemigqaliselo yokususa izicubu zengqondo ngaphezu kwezinye iinkqubo zendabuko. Iquka ukukhutshwa kweemali ezilinganiselwe zeengxube zengqondo kunye nokuqhaqhaqhaqhaqhaqhaqhaqhaqhaqhaqhaqhaqha phakathi kweengqondo, kunye nokusika yonke okanye inxalenye ye-corpus callosum.
Njengoko unokulindela, iinkqubo ezibanzi kakhulu zinombutho ophezulu kunye neengxaki.
Ukulungiselela
Ngaphambi kokuba utyunjiswe, uya kufuna iimvavanyo zangaphambi kokuhlinzwa. Ezi zivivinyo zichonga ukuba utyando lwe-stroke kulindeleke ukuba luncede, luphi uhlobo lotyando olulungile kuwe, kwaye uncede uncedo oogqirha bakho ekucwangciseni inkqubo ngokwayo. Iindawo zemimandla ekufuneka zisuswe zikhethiweyo ukuba ziphephe ukudala ukulahleka kwengqondo. Ezinye iimvavanyo onokuzifuna phambi kwe-hemispherectomy ziquka:
- I-EEG: I-EEG yi-electroencephalogram, okuyiyo vavanyo engavumelekiyo eyenza umsebenzi wombane wengqondo ngokubeka ngokugqithiseleyo i-electrodes ephathekayo kwi-scalp. Olu vavanyo lunokukunceda ukuba yintoni ummandla wengqondo ojongene nokuthintela. Kwimeko yokucwangcisa i-hemispherectomy, i-EEG inokuchonga ukuba yeyiphi indawo ekufuneka isuswe okanye ikhutshwe ngenxa yokulawula ukutshatyalaliswa okukhulu.
- I-EEV yeVidiyo: Lo vavanyo lwe-EGG oluhambelana nokubeka iliso kwividiyo. I-EEV yeVidiyo ivumela iqela lakho lezonyango ukuba liqwalasele indlela ukuqhutyelwa komsebenzi we-EEG ukubonakalisa ngayo kwaye xa iziganeko zakho zokubamba iingxaki ziqala ngokubhekiselele kwiinguqu zakho ze-EEG. Ukuphawula lo mbutho kunokunceda ekucwangciseni inkqubo yakho, ingakumbi ukuba unemizekelo emininzi yokuthintela kunye nemimandla ethile yomsebenzi ongaqhelekanga ophawuliweyo kwi-EEG.
- I-MRI yeBongo: I-MRI yengqondo yinkcazelo ebanzi yengqondo. Ingakwazi ukuchonga inzala (ukusuka ekuzalweni) okungaqhelekanga kunye nokufumanisa okungaqhelekanga okungabangela ukuba uthinteke.
- I-PET iskena: Lo vavanyo lokujonga i-metabolism (umsebenzi wokusebenzisa amandla) kwiindawo ezahlukeneyo zobuchopho. Kungenokuba luncedo ekuqaliseni indawo ye-anatomiki yokubanjwa kwakho.
- Uvavanyo lwe-WADA: Olu vavanyo luvavanya indawo yokusebenza kolwimi kwingqondo yakho. Uvavanyo lwe-WADA alusebenziswanga ukuchonga umsebenzi wokungena okanye indawo kodwa isetyenziselwa ukukunceda ngokucwangcisekileyo inkqubo yakho yokunciphisa ukulahleka komsebenzi emva kokuhlinzwa.
Inkqubo
Inkqubo yakho ifanelwe wena ngokusekelwe kukuvavanywa kwakho kwangaphambi kokuvanywa, kwaye akuvumelekanga ukuba ifane neyona ndlela yomntu.
Ukuhlinzwa okwenziwa yi-hémispherectomy kubandakanya ukudala ukuvula kwinxalenye yengqayi ukufumana ukufikelela kwengqondo, nokususa ngokucophelela ummandla wengqondo echongiwe ukususwa ngaphambi kokuhlinzwa. Ngethuba lokuhlinzwa, iinkalo oogqirha bakho baceba ukuzinqumla, ezifana ne-corpus callosum, bahlulwe ngokucophelela. Kwaye nayiphi na ithambo elalikhutshwe ngexesha lotyando libuyiselwa endaweni efanelekileyo kwigumbi lokusebenza.
Windricular Shunt
Uninzi lwabantu abane-hemispherectomy badinga i- ventricular shunt , ngokuqhelekileyo ixeshana. Le ityhubhu eqokelela i-fluid ukukhusela ukwanda kwamanzi okwakhiwa kokungcolisa ingqondo.
Utyando lwebongo ngokwayo lwenza ukuba kubekho ukukhawuleza kwesikhashana. Ukususwa kweethambo zengqondo kubangela ukwakhiwa kwe-fluid, eqhubela kwindawo esanda kuzaliswa. Nangona kunjalo, ngokuhamba kwexesha, ibhalansi yamanzi ilindeleke ukuba imise. Ukuba kukho ingxaki enokuqhubekayo yokwakha amanzi, i-shunt ingagcinwa ixesha elide.
Ukubuyisela
Njengoko uphila kwi-operesheni, uya kufuna ukuvavanya okufutshane. Uza kukhangela kwi-scalp yakho kwaye ithambo lakho liya kuphulukisa ngokwabo.
Njengoko uphila, iqela lakho lezonyango livavanya izinga lakho lokulumkisa kunye nomsebenzi wakho wegazi ukubeka iliso ekuphuculeni kunye nokufumanisa nayiphi na ingxaki, njengokuphuma kwegazi okanye ukuvuvukala. I-shunt yakho iya kujongwa ngokukhawuleza kwinqanaba elikhuphakileyo, igazi, kunye nemiqondiso yesifo. Oku kunokukunceda iqela lakho lezonyango libambe kwaye likhusele iingxaki ngaphambi kokuba ziqhube phambili.
Unokuziva ungcolise okanye unqabile kwaye ungadinga uncedo ngokutya okanye kunye neminye imisebenzi yakho yokuphila kwansuku zonke, njengokuya kwindawo yokuhlambela nokuhlamba, iintsuku ezimbalwa okanye kwiiveki ezimbalwa. Kufuneka ulindele ukuqina, ukuphucula ibhalansi yakho kwaye uhlale uzimele ngaphezu kweentsuku kunye neeveki emva kokuhlinzwa.
Njengoko uphila, qiniseka ukuxelela iqela lakho lezonyango malunga nayiphi na imvakalelo engavamile ebonakala ibanjwe ukuthunjwa okanye i-aura.
Iziphumo
Kulandelelwano, abaninzi abantu abanesipiliyoni se-hemispherectomy ekuphuculeni kakhulu ukukhwabanisa. Abanye abantu bafumana uphuculo olupheleleyo lwezohlunu zabo kwaye banako ukuyeka ukuthatha imithi yokulwa ne-anti-seizure emva kwenkqubo. Uninzi lwabantu abane-hemispherectomy imfuneko yokuqhubeka nokuthatha imithi yokulwa noxinzelelo lokulawula ukuthunjwa, kodwa bayakwazi ukuthatha amayeza amaninzi okunyamezelayo phambi kokuhlinzwa.
Ngamanye amaxesha, ukuphindaphinda i-hemispherectomy kungafuneka, kwaye iziphumo ezichazwe kwi-hemispherectomy ziyinto enhle. Akunqabile ukuba ukuxhatshazwa kuqhube kakubi emva kwe-hemispherectomy.
ILizwi
I-hemispherectomy yinkqubo ebalulekileyo yokuqapha. Ukuba usuqwalasele i-hemispherectomy yokulawulwa kwesohlwayo, kufuneka ukwazi ukuba inkqubo yenziwa ngabagqirha abanamava aqeqeshiwe ekutyunjweni kwesithuthwane kunye nokuqinisekiswa kwindlela yokuhlinzwa kwengqondo. I-pros and cons of therapy, i-nerve stimulators, kunye neenkqubo zokucwangcisa ukungenelela zilinganiswa ngokucophelela ukuqinisekisa ukuba iindlela ezikhuselekileyo kunye nezona zikhethileyo zikhethwe ukulawulwa kwakho ngokuthe ngqo.
Ukuba i-hemispherectomy ikhethwe njengendlela ekhethekileyo kuwe, ukuhlolwa kwakho kwangaphambi kokuvuthwa kunganciphisa okanye kuphelise ngokupheleleyo ukulahlekelwa komsebenzi wengqondo ukusuka kutyando. Ukuba udinga ukuthatha imithi okanye ukuphinda uphenywe, iziphumo ngokulawulwa kokuthintela kunye nemiphumo yecala iyabaleka, kunye nabantu abaninzi banokubanjelwa kancinci nangaphantsi kwe-hemispherectomy kunokuba benze ngaphambi kokuhlinzwa.
> Imithombo:
> Chen S, Guan Y, Liu C, et al. Unyango lwezigulane ezinesifo sokuhluthwa okungafunekiyo emva kokuqala kwe-hemispherectomy. Isifo sokufa. 2017; 139: 137-142. i-doi: 10.1016 / j.eplepsyres.2017.11.021.