Deepara ƙarfin kwakwalwa

Brainara ƙarfin ƙwaƙwalwar ƙwaƙwalwa (DBS) yana amfani da na'urar da ake kira neurostimulator don sadar da siginonin lantarki zuwa ɓangarorin ƙwaƙwalwar da ke kula da motsi, zafi, yanayi, nauyi, yawan tunani-tilasta tunani, da farkawa daga suma.

Tsarin DBS ya kunshi sassa hudu:

• Oraya ko fiye, wayoyi masu rufi da ake kira jagora, ko wayoyi, waɗanda ake sanya su cikin kwakwalwa
• Anga don gyara hanyoyin kaiwa zuwa kwanyar
  
• Neurostimulator, wanda ke fitar da wutar lantarki. Mai kuzari yayi kama da bugun zuciya. Yawanci ana sanya shi a ƙarƙashin fata kusa da ƙwanƙwasa, amma ana iya sanya shi a wani wuri a cikin jiki
• A cikin wasu mutane ana ƙara wata sirarren, waya mai ɗauri wanda ake kira tsawo don haɗa gubar zuwa neurostimulator

Ana yin aikin tiyata don sanya kowane ɓangare na tsarin neurostimulator. A cikin manya, ana iya sanya dukkan tsarin a matakai 1 ko 2 (tiyata daban biyu).

Mataki na 1 galibi ana yin sa ne a cikin maganin rigakafin gida, ma’ana kuna a farke, amma ba ku da zafi. (A cikin yara, ana ba da maganin rigakafi na gaba ɗaya.)

• Za a iya aske ɗan gashin da ke kan ku.
• An sanya kanka a cikin firam na musamman ta amfani da ƙananan sukurori don kiyaye shi har yanzu yayin aikin. Ana amfani da maganin Nono a inda dunƙulen ya shafi fatar kan mutum. Wani lokaci, ana yin aikin a cikin injin MRI kuma firam yana saman kanka maimakon kewaye da kai.
• Ana amfani da maganin ƙidayar numfashi a fatar kai a wurin da likita zai buɗe fatar, sannan a huda ƙaramar buɗewa a cikin kwanyar ya sanya gubar zuwa wani yanki na ƙwaƙwalwa.
• Idan ana kula da bangarorin biyu na kwakwalwar ku, likitan zaiyi budewa a kowane gefen kwanyar, sannan a saka maguna biyu.
• Mayarfin wutar lantarki na iya buƙatar aikawa ta cikin jagorar don tabbatar da haɗa ta da yankin ƙwaƙwalwar da ke da alhakin alamun ku.
• Za a iya yi muku tambayoyi, don karanta katunan, ko bayyana hotuna. Hakanan za'a iya tambayarka don matsar da ƙafafunku ko hannuwanku. Waɗannan sune don tabbatar da wayoyin suna cikin madaidaitan matsayi kuma an sami sakamako mai tsammanin.
  

Mataki na 2 ana yin sa ne a cikin maganin rigakafi na gaba ɗaya, ma'ana kuna barci kuma ba ku da ciwo. Lokacin wannan matakin tiyatar ya dogara da inda za'a sanya mai kuzarin a cikin kwakwalwa.

• Dikita yayi karamin budewa (incision), yawanci a kasa da wuyan wuyan kuma ya sanya neurostimulator. (Wani lokacin akan sanya shi a ƙarƙashin fata a ƙasan kirji ko yankin ciki.)
• An saka waya mai shimfiɗa a ƙarƙashin fata na kai, wuya, da kafaɗa kuma an haɗa ta da neurostimulator.
• Isionarƙarar ta rufe. Ba za a iya ganin na'urar da wayoyi a waje ba.

Da zarar an haɗa su, bugun lantarki suna tafiya daga neurostimulator, tare da wayar tsawo, zuwa jagora, da cikin kwakwalwa. Wadannan ƙananan ƙwayoyin cuta suna tsoma baki tare da toshe alamun lantarki waɗanda ke haifar da alamun wasu cututtuka.

Ana amfani da DBS don mutanen da ke da cutar Parkinson lokacin da magunguna ba za su iya sarrafa alamun ba. DBS ba ya warkar da cutar Parkinson, amma yana iya taimakawa rage alamun kamar:

• Girgizar ƙasa
• Rigidity
• Tianƙara
• Sannu a hankali
• Matsalar tafiya

Hakanan za'a iya amfani da DBS don bi da waɗannan sharuɗɗan:

• Babban damuwa wanda baya amsawa da kyau ga magunguna
• Rashin hankali-tilasta cuta
• Jin zafi wanda baya tafiya (ciwo na kullum)
• Tsanani kiba
• Girgiza motsi wanda baza'a iya sarrafawa ba kuma sanadin sananne (mahimmin rawar ƙasa)
• Ciwon Tourette (a wasu lokuta)
• Rashin sarrafawa ko jinkirin motsi (dystonia)

Ana daukar DBS amintacce kuma mai tasiri idan aka yi shi cikin mutanen da suka dace.

Risks na sanya DBS na iya haɗawa da:

• Rashin lafiyan ga sassan DBS
• Matsalar tattara hankali
• Dizziness
• Kamuwa da cuta
• Rashin zubowar ruwan sankara, wanda ke haifar da ciwon kai ko sankarau
• Rashin daidaituwa, rage daidaituwa, ko ɗan asarar motsi
• Shock-kamar majiyai
• Matsalar magana ko hangen nesa
• Jin zafi na ɗan lokaci ko kumburi a wurin da aka dasa na'urar
• Jin ƙai na ɗan lokaci a fuska, hannu, ko ƙafa
• Zuban jini a cikin kwakwalwa

Hakanan matsaloli na iya faruwa idan sassan tsarin DBS suka karye ko suka motsa. Wadannan sun hada da:

• Na'ura, gubar, ko wayoyi sun karye, wanda zai iya haifar da wani tiyata don maye gurbin ɓangaren da ya karye
• Baturi ya gaza, wanda zai sa na'urar ta daina aiki yadda yakamata (batir na yau da kullun yakan ɗauki shekaru 3 zuwa 5, yayin da batirin da ake cajin ya kwashe shekaru 9)
• Wayar da ke haɗa na'urar motsa jiki da gubar a cikin kwakwalwa ta ratsa fata
• Sashin na'urar da aka sanya a cikin kwakwalwa na iya fashewa ko motsawa zuwa wani wuri daban a cikin kwakwalwa (wannan ba safai ba)

Hadarin da ke tattare da duk wata tiyatar kwakwalwa shine:

• Jinin jini ko zubar jini a cikin kwakwalwa
• Kumburin kwakwalwa
• Coma
• Rikici, yawanci yakan kasance na kwanaki ne kawai ko makonni a mafi akasari
• Kamuwa da cuta a cikin kwakwalwa, a cikin rauni, ko a cikin kwanyar mutum
• Matsaloli game da magana, ƙwaƙwalwar ajiya, raunin tsoka, daidaitawa, hangen nesa, daidaitawa, da sauran ayyuka, waɗanda na iya zama na ɗan lokaci ko na dindindin
• Kamawa
• Buguwa

Hadarin da ke tattare da maganin rigakafin cutar gaba daya shine:

• Amsawa ga magunguna
• Matsalar numfashi

Za ku sami cikakken gwajin jiki.

Likitanku zai yi oda da yawa dakin gwaje-gwaje da gwaje-gwaje na hoto, gami da hoton CT ko MRI. Ana yin waɗannan gwaje-gwajen hotunan ne don taimakawa likitan likita gano ainihin ɓangaren ƙwaƙwalwar da ke da alhakin alamun. Ana amfani da hotunan don taimakawa likitan likita don sanya gubar a cikin kwakwalwa yayin aikin tiyata.

Wataƙila dole ne ku ga ƙwararru fiye da ɗaya, kamar likitan jijiyoyin jiki, likitan jijiyoyi, ko kuma masanin halayyar ɗan adam, don tabbatar da cewa aikin ya dace da ku kuma yana da mafi kyawun damar nasara.

Kafin aikin tiyata, gaya wa likitanka:

• Idan kanada ciki
• Waɗanne magunguna kuke sha, haɗe da ganye, kari, ko kuma bitamin da kuka siya a kan kantin ba tare da takardar sayan magani ba
• Idan kana yawan shan giya

A lokacin kwanakin kafin aikin:

• Mai ba ka kiwon lafiya na iya gaya maka ka ɗan dakatar da shan abubuwan rage jini. Wadannan sun hada da warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), aspirin, ibuprofen, naproxen, da sauran NSAIDs.
• Idan kuna shan wasu magunguna, ku tambayi mai ba ku sabis ko ya dace ku sha su a ranar ko a kwanakin kafin aikin tiyata.
• Idan ka sha taba, yi ƙoƙari ka daina. Tambayi mai ba ku taimako.

Daren da ya gabata da ranar tiyata, bi umarni game da:

• Ba a shan komai ko cin komai na tsawon awanni 8 zuwa 12 kafin a yi aikin.
• Wanke gashinku da shamfu na musamman.
• Theauki magungunan da mai bayarwa ya gaya muku ku sha da ɗan ƙaramin shan ruwa.
• Zuwana asibiti akan lokaci.

Kuna iya buƙatar zama a asibiti na kimanin kwanaki 3.

Dikita na iya rubuta maganin rigakafi don hana kamuwa da cuta.

Za ku dawo zuwa ofishin likitanku a wani lokaci bayan tiyata. A yayin wannan ziyarar, an kunna mai motsa kuzari kuma an daidaita adadin abin motsawa. Ba a buƙatar yin tiyata. Wannan tsari kuma ana kiransa programing.

Tuntuɓi likitan ku idan kun haɓaka ɗayan masu zuwa bayan aikin DBS:

• Zazzaɓi
• Ciwon kai
• Yin ƙaiƙayi ko amya
• Raunin jijiyoyi
• Tashin zuciya da amai
• Jin ƙyama ko ƙwanƙwasawa a gefe ɗaya na jiki
• Jin zafi
• Redness, kumburi, ko hangula a kowane wurin aikin tiyata
• Matsalar magana
• Matsalar hangen nesa

Mutanen da ke da DBS yawanci suna yin kyau yayin aikin tiyata. Mutane da yawa suna da babban ci gaba a cikin alamun su da ingancin rayuwa. Yawancin mutane har yanzu suna buƙatar shan magani, amma a ƙananan sashi.

Wannan tiyatar, da tiyata gabaɗaya, tana da haɗari a cikin mutane sama da shekaru 70 da waɗanda ke da yanayin lafiya kamar hawan jini da cututtukan da ke shafar jijiyoyin jini a cikin kwakwalwa. Ku da likitan ku yakamata ku auna fa'idar wannan tiyata a kan haɗarin.

Za'a iya juya tsarin DBS, idan an buƙata.

Globus pallidus zurfin ƙwaƙwalwar ƙwaƙwalwa; Twayar zurfin ƙwaƙwalwar ƙwaƙwalwa; Thalamic zurfin ƙwaƙwalwar ƙwaƙwalwa; DBS; Neurowayar kwakwalwa

Johnson LA, Vitek JL. Deepwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa: hanyoyin aiwatarwa. A cikin: Winn HR, ed. Youmans da Winn Yin aikin tiyata. 7th ed. Philadelphia, PA: Elsevier; 2017: babi na 91.

Lozano AM, Lipsman N, Bergman H, et al. Brainwaƙwalwar ƙwaƙwalwa mai zurfi: ƙalubale na yanzu da kuma makomar gaba. Nat Rev Neurol. 2019; 15 (3): 148-160. PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Rundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Brainaramar kwakwalwa. A cikin: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology a cikin Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016: babi na 37.