He aha inā loaʻa koke iā ʻoe kahi ʻeha poʻo nui e like me ka mea āu i ʻike ʻole ai i kou ola? A i ʻole inā loaʻa koke iā ʻoe kahi maʻi e like me ka hopu ʻana me ke kumu ʻole? ʻOiai ke manaʻo pinepine nei mākou he mea maʻamau kēia mau mea, i kekahi manawa aia paha ke kumu ma hope o kēia ʻaʻole mākou i lohe nui e pili ana, akā pono mākou e hopohopo nui. ʻO ia kekahi ʻano maʻi kakaikahi, akā he mea koʻikoʻi paha a mākou e kamaʻilio nei i kēia lā, i kapa ʻia ʻo AVM.
I ka ʻōlelo maʻalahi, he aha kēia AVM (Arteriovenous Malformation)?
E noʻonoʻo i ke kahe koko i loko o ko kākou kino e like me kahi ʻōnaehana o nā alanui. Ua like nā aʻa me nā alaloa. Lawe lākou i ke koko maʻemaʻe a waiwai i ka oxygen mai ka puʻuwai a i ka lolo a me nā ʻōpū ʻē aʻe a pau. Ua like nā aʻa me nā alanui liʻiliʻi. Lawe lākou i ke koko i hoʻohana ʻia a nele i ka oxygen i ka puʻuwai.
Aia kahi hui ma waena o kēia mau alaloa (nā aʻa) a me nā alanui liʻiliʻi (nā veins) e hoʻonohonoho a kāohi i ka wikiwiki. ʻO kēia hui ʻana ka pūnaewele o nā kīʻaha koko liʻiliʻi a mākou e kapa nei he capillaries. ʻO kēia kahi e hoʻemi ʻia ai ke kaomi o ke koko e hele mai ana mai ke alaloa, hāʻawi ʻia ka oxygen a me nā meaʻai i nā ʻiʻo a puni, a laila hoʻouna ʻia i nā veins.
E noʻonoʻo, he aha ka mea e hana ʻia inā, no kekahi kumu, e nalowale ana kēia hui ʻana (capillaries), a e hoʻopili koke ke alaloa (artery) i kahi alanui liʻiliʻi (vein)? Ke holo wikiwiki ke kahe koko wikiwiki a kiʻekiʻe i loko o kahi aʻa palupalu i hiki ʻole ke hoʻomanawanui i ke kaomi, hiki i kēlā aʻa ke pohā.
ʻO kēlā hiʻohiʻona ʻē a hiʻohiʻona o nā kīʻaha koko, ʻo ia ka mea a mākou e kapa nei he Arteriovenous Malformation , a i ʻole AVM . ʻO kēia hiʻohiʻona hiʻohiʻona, e like me ka pūnana manu, hiki ke hoʻoweliweli nui.
ʻElua mau ʻano nui o nā AVM:
ʻOiai hiki i nā AVM ke ulu ma nā wahi āpau o ko mākou kino, hiki ke puʻunaue nui ʻia i ʻelua ʻano.
| ʻAno AVM | Kahi a me ka wehewehe |
|---|---|
| Nā AVM lolo | ʻO kēia nā mea maʻamau. Hiki iā lākou ke ulu i loko o ka ʻiʻo o ka lolo, ma ka ʻili o ka lolo, ma ke kumu o ka lolo, a i ʻole ma ke kaula kuamoʻo. ʻO kēia nā mea weliweli loa. |
| ʻO nā AVM e kū nei ma nā wahi ʻē aʻe o ke kino (Peripheral AVMs) | Hiki i kēia mau mea ke hana ma nā wahi āpau ma waho o ka lolo. Eia kekahi laʻana, hiki i kēia mau nodules ke hana i nā ʻōpū e like me ka maka, nā lima, nā wāwae, ka puʻuwai, ke akepaʻa, a i ʻole nā māmā. |
He aha nā hōʻailona o kahi AVM?
ʻO ka mea kupaianaha e pili ana i kēia, ʻo ia ka 15% o ka poʻe me ka AVM ʻaʻole hōʻike i kekahi mau hōʻailona. ʻO ka hapa nui o ka manawa, ʻike wale ʻoe he hoʻokahi kāu ma hope o ka pahū ʻana a hoʻomaka ke kahe ʻana o ke koko i loko o ka lolo. Eia nō naʻe, hiki i kekahi poʻe ke ʻike i kekahi mau hōʻailona.
| Māhele hōʻailona | Nā hōʻailona hiki ke loaʻa |
|---|---|
| Nā hōʻailona e pili ana i ka lolo | |
| Nā pilikia o ka ʻōnaehana nerve | - Nā ʻōʻō me ka ʻike ʻole a i ʻole me ka ʻike ʻole. - ʻEha poʻo koʻikoʻi a koke. - Ka nāwaliwali o nā ʻiʻo a i ʻole ka maʻi lolo piha ma kekahi ʻaoʻao o ke kino. - Ka mae ʻana o ke kino. - Nā pilikia me ka hele wāwae, ka ʻōlelo ʻana, ka hoʻomanaʻo, ka noʻonoʻo ʻana, a i ʻole ka ʻike. |
| Nā pilikia noʻonoʻo a me ka naʻau | - Ka luaʻi a me ka luaʻi. - Pōʻaiʻū. - Huikau noʻonoʻo a i ʻole nā mea hilahila. |
| Nā Hōʻailona ma nā ʻĀpana Kino ʻē aʻe | |
| Nā māmā, ka iwi kuamoʻo, a me ka ʻōpū | - Inā aia ka AVM i loko o nā māmā, hiki iā ʻoe ke loaʻa i ka pōkole o ka hanu a i ʻole ke ʻūhā ʻana o ke koko i ka wā e hoʻoikaika kino ai. - Inā aia ka AVM i loko o ke kaula kuamoʻo, ʻeha nui koke ke kua a me ka maneʻo o nā wāwae. - ʻEha ʻōpū. |
| Nā lālā a me ka ʻili | - Nā puʻupuʻu e ʻike ʻia ana ma nā lima, nā wāwae, a i ʻole ke kino. - ʻEha a me ka pehu ʻana ma ka wahi i hoʻopilikia ʻia. |
No ke aha i hoʻokumu ʻia ai kēia mau AVM?
ʻAʻole ʻike maopopo nā kānaka ʻepekema i ke kumu pololei o kēia maʻi, akā manaʻoʻiʻo lākou he maʻi hānau mua ia. ʻO ke ʻano kēia, hana ʻia nā puʻupuʻu aʻa koko i ka wā e ulu ana ka pēpē i loko o ka ʻōpū. He mea kākaʻikahi loa, hiki ke hoʻoili ʻia i nā hanauna.
He aha ka pōʻino e hiki ai i kahi AVM ke hana i ke kino?
ʻO ka loaʻa ʻana o kahi AVM hiki ke hana i ʻekolu mau pōʻino nui:
- Ke kahe ʻana o ke koko: ʻO kēia ka pilikia nui loa a weliweli loa . Ke komo ke koko e kahe ana mai nā aʻa koko ma lalo o ke kaomi kiʻekiʻe i loko o nā aʻa koko nāwaliwali i hiki ʻole ke kū i ke kaomi, hiki i nā aʻa koko ke pohā. Inā puka kēia kahe ʻana o ke koko i loko o ka lolo, hiki iā ia ke hana i ka hahau ʻana, e hōʻeha mau ana i ka lolo a i ʻole ka make.
- Ke kaomi ʻana ma luna o nā ʻiʻo a puni: I ka piha ʻana o ke koko i ke ʻano ʻē, hiki i kēia kīʻaha koko ke hoʻonui a kaomi ma luna o nā wahi lolo a i ʻole nā aʻalolo a puni. Hiki i kēia ke hana i nā hōʻailona e like me nā hopu ʻana a me ka nāwaliwali o nā ʻiʻo.
- Ka hoʻopau ʻana i ka oxygen i nā ʻiʻo: No ka mea, ua nele nā hui capillary a mākou i ʻōlelo ai ma mua, ʻaʻole i hoʻololi ʻia ka oxygen a me nā meaʻai i loko o ke koko me nā ʻiʻo a puni. Hele pololei ke koko mai ke aʻa a i ke aʻa. ʻO ka hopena, ʻaʻole loaʻa i nā ʻiʻo a me nā hunaola nerve ma ia wahi ka meaʻai e pono ai a hiki ke make.
Pehea e ʻike ai ke kauka i kēia?
Ma hope o ka hoʻolohe ʻana i kāu mau hōʻailona, e nānā kāu kauka iā ʻoe. I kekahi manawa, i ka hoʻolohe ʻana me ka stethoscope, lohe paha ʻoe i kahi leo "bruit" kūikawā, i hoʻokumu ʻia e ke kahe wikiwiki o ke koko ma o ka AVM.
Akā no ka hōʻoia pono ʻana inā loaʻa kahi AVM, pono e hana ʻia kekahi mau hoʻokolohua kiʻi kūikawā.
- MRI (Magnetic Resonance Imaging): Hiki ke hoʻohana ʻia nā nalu magnetic e kiʻi i nā kiʻi maopopo loa o ka lolo a me nā kīʻaha koko.
- ʻO ke kiʻi CT (Computed Tomography): Loaʻa ʻia kekahi mau kiʻi ʻokiʻoki o ka lolo me ka hoʻohana ʻana i nā kukuna X.
- ʻO ka Catheter Angiography: ʻO kēia ka hoʻāʻo maikaʻi loa e ʻimi ai i kahi AVM. Ma kēia hoʻāʻo, hoʻokomo ʻia kahi paipu liʻiliʻi (catheter) ma o kahi aʻa koko ma ka ʻūhā a i ʻole ka lima a alakaʻi ʻia i nā kīʻaha koko ma ka lolo. A laila hoʻokomo ʻia kahi kala kūikawā i loko o nā kīʻaha koko, e ʻae ana i ka wahi, ka nui, a me ke ʻano o ke kīʻaha koko e ʻike maopopo ʻia ma nā kukuna X.
He aha nā lāʻau lapaʻau no nā AVM?
ʻO ka hoʻoholo e mālama i kahi AVM, a inā pēlā, he aha ka lāʻau e hoʻohana ai, e hilinaʻi ʻia ma kekahi mau kumu. E noʻonoʻo kāu kauka i kou makahiki, olakino, ka nui a me kahi o ka AVM, a me ka pilikia o ka haki ʻana.
ʻO ka pahuhopu nui o ka mālama ʻana, ʻo ia ka hōʻemi a hoʻopau loa paha i ka pilikia o ke kahe ʻana o ke koko.
| ʻAno lapaʻau | Pehea e hana ai |
|---|---|
| ʻoki kino | ʻO kēia ka lāʻau lapaʻau holomua loa. Hana kahi neurosurgeon i kahi ʻoki liʻiliʻi ma ka lolo, pani i nā kīʻaha koko e hoʻolako koko i ka AVM a me nā kīʻaha koko e hoʻokahe iā ia, a wehe loa i ke kīʻaha koko. Inā wehe loa ʻia ka AVM, ua ho'ōla ʻia ka maʻi. |
| Hoʻopili ʻana | ʻAʻole kēia he hana. E like me ka angiography, hoʻokomo ʻia kahi catheter i loko o ka AVM a hoʻokomo ʻia kahi mea pili kūikawā a i ʻole nā wili uea liʻiliʻi ma o ia mea e hoʻōki i ke kahe koko i loko o ke kīʻaha koko. Hoʻohana ʻia kēia kaʻina hana i kekahi manawa e hōʻemi i ka pilikia ma mua o ke ʻoki ʻana. |
| ʻO ke keʻena lapaʻau radio Gamma Knife® | ʻAʻole hoʻi kēia he ʻoki kino. Maanei, ua kuhikuhi ʻia ka nui o nā kukuna radiation i ka AVM me ka pololei loa. ʻO kēia radiation ke kumu o ka emi mālie ʻana o ke kīʻaha koko, pani ʻia, a lilo i mea hana ʻole i loko o kekahi mau mahina a i ʻole nā makahiki. |
Eia kekahi, hiki i kāu kauka ke kuhikuhi i nā lāʻau lapaʻau e kāohi i nā hōʻailona e like me ka hopu ʻana a i ʻole ke poʻo.
I ka manawa hea e ʻimi koke ai i ke kōkua lapaʻau!
He pilikia ia inā loaʻa i kekahi me ka AVM kekahi mau hōʻailona.
Inā loaʻa koke iā ʻoe a i ʻole kekahi mea āu i ʻike ai ke "ʻeha poʻo ʻino loa o koʻu ola", nā hahau, ka nalowale ʻana o kahi lālā, a i ʻole ka paʻakikī o ka ʻike/ʻōlelo ʻana, e hele koke i ka Halemai Pilikia (ETU) kokoke loa.
Hiki i kēia ke lilo i mau hōʻailona o ke kahe ʻana o ke koko i loko o ka lolo. ʻO ka loaʻa koke ʻana o ka lāʻau lapaʻau hiki ke hoʻopakele i nā ola a hōʻemi i ka pōʻino o ka lolo.
Leka Lawe-Home
- He ʻōkō koko kakaikahi ka AVM akā he mea weliweli paha i loaʻa i ka wā hānau.
- ʻO ka pilikia nui a weliweli loa o kēia, ʻo ia ka hiki ke pahū a hoʻoulu i ke kahe koko i loko o ka lolo (stroke) .
- ʻAʻohe hōʻailona o ka hapa nui o ka poʻe. Akā inā ʻike ʻoe i nā hōʻailona e like me ka ʻeha poʻo koke, ka ʻeha nui, nā hopu ʻana, a i ʻole ka nāwaliwali ma kekahi ʻaoʻao o kou kino, he pilikia ia. E hele koke i ka ETU .
- I kēia lā, aia nā ʻano lapaʻau holomua loa e like me ke ʻoki ʻana, embolization, a me ka radiosurgery.
- Inā ua ʻike ʻia ʻoe me kahi AVM, mai hopohopo. E kamaʻilio ākea me kāu kauka e pili ana i ka lāʻau lapaʻau maikaʻi loa no kou kūlana.
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