Die intraoperative Faszikel-topografische Elektromyografie in der peripheren Nervenchirurgie – Übersichtsarbeit und Fallbeispiele

Zusammenfassung

In der peripheren Nervenchirurgie ist die intraoperative Beurteilung eines pathologischen Nervensegmentes von zentraler Bedeutung. Mittels verschiedener Methoden kann die Vitalität eines Nervs beurteilt und zwischen alleiniger Neurolyse oder Resektion und Nervenrekonstruktion entschieden werden. Neben Nervenmorphologie, intraoperativer Schnellschnittdiagnostik und einfacher Nervenstimulation ist die intraoperative Elektrophysiologie ein wertvolles Instrument des Nervenchirurgen. Ziel dieser apparativen Diagnostik ist das Erfassen objektiver Parameter, welche die Funktion peripherer Nerven dokumentieren. Die intraoperative Elektroneurografie erlaubt die Ableitung eines Nervenaktionspotentials über einem pathologisch veränderten Nervensegment und ist seit vielen Jahren etabliert. Im Gegensatz dazu wird die intraoperative Nadel-Elektromyografie in der peripheren Nervenchirurgie noch kaum benutzt, obwohl sie interessante Vorteile mit sich bringt. Sie kann sowohl bei der Selektion geeigneter Faszikel für motorische Neurotisationen als auch bei der Faszikel-topografischen Ableitung von Kontinuitätsneuromen wertvolle Zusatzinformationen generieren. Die vorliegende Übersichtsarbeit fasst die Möglichkeiten der intraoperativen Elektromyografie anhand von Fallbeispielen aus der Traumatologie und Tumorchirurgie zusammen.

Abstract

The intraoperative assessment of a pathological nerve segment is crucial in peripheral nerve surgery. Based on different techniques the function of a peripheral nerve is analyzed and either a neurolysis alone or a resection with subsequent nerve reconstruction is performed. Beside the morphological and histological assessment or the use of a nerve stimulator, intraoperative electrophysiology is highly useful. The aim of this diagnostic tool is the recording of objective parameters, documenting the function of peripheral nerves. Intraoperative electroneurography allows the assessment of a nerve action potential over a pathological nerve segment and has been used for decades. In contrast, additional needle electromyography is rarely used even though this technique is characterized by interesting advantages: It is very helpful for the selection of donor fascicles during neurotization surgeries and for the electrophysiological assessment of neuromata in continuity. In the present review, we discuss the value of intraoperative electromyography in the treatment of peripheral nerve trauma as well as peripheral nerve tumors.

Schlüsselwörter

Plexus brachialis - Plexuschirurgie beim Erwachsenen - Chirurgie der peripheren Nerven - Nerventumoren - intraoperative Elektrophysiologie

Key words

Peripheral nerve surgery - intraoperative electrophysiology - brachial plexus - nerve tumours

^* Geteilte Erstautorenschaft

Publikationsverlauf

Eingereicht: 19. Dezember 2020

Angenommen: 16. April 2021

Artikel online veröffentlicht:
23. September 2021

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