RSS-Feed abonnieren
DOI: 10.1055/s-0031-1281762
© Georg Thieme Verlag KG Stuttgart · New York
Ultraschallgezielte Interventionen an peripheren Nerven: diagnostische und therapeutische Indikationen
Ultrasound-Guided Interventions at Peripheral Nerves: Diagnostic and Therapeutic IndicationsPublikationsverlauf
eingereicht: 5.9.2011
angenommen: 5.9.2011
Publikationsdatum:
10. Oktober 2011 (online)

Kernaussagen
-
US-geleitete Interventionen an peripheren Nerven erfolgen unter Verwendung einer externen Führung oder in „Freihandtechnik” unter Verwendung optimierter US-Technik zur Darstellung der Nadel („In-Plane-Technik”) und der Zielstruktur bzw. -pathologie.
-
Die Gewebediagnostik suspekter peripherer Nerventumoren erfolgt unter Verwendung der Schneidbiopsie mit mindestens 3 Gewebeproben. Empfohlen wird die Verwendung einer Koaxialtechnik. US-Kontrastmittel können helfen, vitales, vaskularisiertes Gewebe von Nekrose zu differenzieren und erhöhen die Zahl diagnostisch verwertbarer Biopsien.
-
Die ultraschallgeleitete Regionalanästhesie an der oberen und unteren Extremität hat im Vergleich zur „blinden” Vorgehen den Vorteil einer höheren Effektivität bei geringerer Komplikationsrate.
-
Die US-geleitete Schmerztherapie an peripheren Nerven und Neuromen optimiert die Applikation von Medikamenten zur temporären und permanenten Schmerzausschaltung ohne Verwendung von Röntgenstrahlen. Am Achsenskelett helfen anatomisch-sonografische Leitstrukturen und ein standardisiertes Vorgehen, die Medikamente direkt an die Wurzel bzw. in das schmerzende Gelenk zu applizieren.
-
Die Therapie symptomatischer Neurome mit Radiofrequenzablation zeigt erste, vielversprechende Ergebnisse, Langzeitbeobachtungen und größere Untersuchungsserien stehen hier aber noch aus.
Main statements
-
US-guided interventions in peripheral nerves are performed using external guidance or the ”freehand technique” with an optimized US method for visualizing the needle (”in-plane technique”) and the target structure or pathology.
-
Tissue diagnostics of suspicious peripheral nerve tumors is performed using incisional biopsy with at least 3 tissue samples. A coaxial technique is recommended.
-
US contrast agents can help to differentiate vital vascularized tissue from necrosis and increase the number of diagnostically viable biopsies. Compared to the ”blind” approach, ultrasound-guided regional anesthesia in the upper and lower extremities has the advantage of higher effectiveness with a lower complication rate.
-
US-guided pain therapy in peripheral nerves and neuromas optimizes the application of medications for temporary or permanent pain relief without the use of X-rays. Anatomical guide structures on the axial skeleton and a standardized approach make it possible to administer medications directly at the root or into the painful joint.
-
The treatment of symptomatic neuromas with radiofrequency ablation has yielded promising first results. However, long-term observations and larger study series are not yet available.
Literatur/References
- 1
Kransdorf M J.
Benign soft-tissue tumors in a large referral population: distribution of specific
diagnoses by age, sex, and location.
Am J Roentgenol.
1995;
164
395-402
MissingFormLabel
- 2
Kransdorf M J.
Malignant soft-tissue tumors in a large referral population: distribution of diagnoses
by age, sex, and location.
Am J Roentgenol.
1995;
164
129-134
MissingFormLabel
- 3 Moore D. Regional Block. Springfield, IL: Thomas; 1954
MissingFormLabel
- 4
Graf B M, Martin E.
Peripheral nerve block. An overview of new developments in an old technique.
Anaesthesist.
2001;
50
312-322
MissingFormLabel
- 5
Kovacs P, Gruber H, Piegger J et al.
New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic
technique.
Dis Colon Rectum.
2001;
44
1381-1385
MissingFormLabel
- 6
Kopf H, Loizides A, Mostbeck G H et al.
Diagnostic Sonography of Peripheral Nerves: Indications, Examination Techniques and
Pathological Findings (Diagnostische Sonografie peripherer Nerven: Indikationen, Techniken
und Pathologien).
Ultraschall in Med.
2011;
32
242-266
MissingFormLabel
- 7
Phal P M, Brooks D M, Wolfe R.
Sonographically guided biopsy of focal lesions: a comparison of freehand and probe-guided
techniques using a phantom.
Am J Roentgenol.
2005;
184
1652-1656
MissingFormLabel
- 8
Singh H K, Kilpatrick S E, Silverman J F.
Fine needle aspiration biopsy of soft tissue sarcomas: utility and diagnostic challenges.
Adv Anat Pathol.
2004;
11
24-37
MissingFormLabel
- 9
Dupuy D E, Rosenberg A E, Punyaratabandhu T et al.
Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms.
Am J Roentgenol.
1998;
171
759-762
MissingFormLabel
- 10
Torriani M, Etchebehere M, Amstalden E.
Sonographically guided core needle biopsy of bone and soft tissue tumors.
J Ultrasound Med.
2002;
21
275-281
MissingFormLabel
- 11
Ogilvie C M, Torbert J T, Finstein J L et al.
Clinical utility of percutaneous biopsies of musculoskeletal tumors.
Clin Orthop Relat Res.
2006;
450
95-100
MissingFormLabel
- 12
Hansen E, Wolff N, Knuechel R et al.
Tumor cells in blood shed from the surgical field.
Arch Surg.
1995;
130
387-393
MissingFormLabel
- 13
Ogilvie C M, Torbert J T, Finstein J L et al.
Clinical Utility of Percutaneous Biopsies of Musculoskeletal Tumors.
Clinical Orthopaedics and Related Research.
2006;
450
95-100
MissingFormLabel
- 14
Mitsuyoshi G, Naito N, Kawai A et al.
Accurate diagnosis of musculoskeletal lesions by core needle biopsy.
J Surg Oncol.
2006;
94
21-27
MissingFormLabel
- 15
Loizides A, Widmann G, Freuis T et al.
Optimizing Ultrasound-Guided Biopsy of Musculoskeletal Masses by Application of an
Ultrasound Contrast Agent.
Ultraschall in Med.
2010;
32(3)
307-310
MissingFormLabel
- 16
Kovacs P, Gruber H, Piegger J et al.
New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic
technique.
Dis Colon Rectum.
2001;
44
1381-1385
MissingFormLabel
- 17
Schwemmer U, Markus C K, Brederlau J et al.
Einsatz von Ultraschall zur Durchführung peripherer Nervenblockaden.
Ultraschall in Med.
2009;
30
6-24
MissingFormLabel
- 18 Bridenbaugh L. The upper extremity: somatic blockade. In: Cousins M, Bridenbaugh P O, editor Neural blockade in clinical anesthesia and management of pain.. Philadelphia: Lippincott; 1988: 387-416
MissingFormLabel
- 19
Goldberg M E, Gregg C, Larijani G E et al.
A comparison of three methods of axillary approach to brachial plexus blockade for
upper extremity surgery.
Anesthesiology.
1987;
66
814-816
MissingFormLabel
- 20
Winnie A P, Ramamurthy S, Durrani Z.
The inguinal paravascular technic of lumbar plexus anesthesia: the ”3-in-1 block”.
Anesth Analg.
1973;
52
989-996
MissingFormLabel
- 21
Ootaki C, Hayashi H, Amano M.
Ultrasound-guided infraclavicular brachial plexus block: an alternative technique
to anatomical landmark-guided approaches.
Reg Anesth Pain Med.
2000;
25
600-604
MissingFormLabel
- 22
Kirchmair L, Entner T, Kapral S et al.
Ultrasound guidance for the psoas compartment block: an imaging study.
Anesth Analg.
2002;
94
706-710
; table of contents
MissingFormLabel
- 23
Marhofer P, Nasel C, Sitzwohl C et al.
Magnetic resonance imaging of the distribution of local anesthetic during the three-in-one
block.
Anesth Analg.
2000;
90
119-124
MissingFormLabel
- 24
Gruber H, Kovacs P, Piegger J et al.
New, simple, ultrasound-guided infiltration of the pudendal nerve: topographic basics.
Dis Colon Rectum.
2001;
44
1376-1380
MissingFormLabel
- 25
Rasmussen M R, Kitaoka H B, Patzer G L.
Nonoperative treatment of plantar interdigital neuroma with a single corticosteroid
injection.
Clin Orthop Relat Res.
1996;
326
188-193
MissingFormLabel
- 26
Al-Nasser B.
Intraneural injection of local anesthetics during ultrasound-guided peripheral nerve
block may lead to nerve injury.
Anesthesiology.
2007;
106
1245-1246
; author reply 7
MissingFormLabel
- 27
Fredberg U.
Local corticosteroid injection in sport: review of literature and guidelines for treatment.
Scand J Med Sci Sports.
1997;
7
131-139
MissingFormLabel
- 28
Westerlund T, Vuorinen V, Roytta M.
Same axonal regeneration rate after different endoneurial response to intraneural
glycerol and phenol injection.
Acta Neuropathol.
2001;
102
41-54
MissingFormLabel
- 29
Gruber H, Kovacs P, Peer S et al.
Sonographically guided phenol injection in painful stump neuroma.
Am J Roentgenol.
2004;
182
952-954
MissingFormLabel
- 30
Gruber H, Glodny B, Kopf H et al.
Practical experience with sonographically guided phenol instillation of stump neuroma:
predictors of effects, success, and outcome.
Am J Roentgenol.
2008;
190
1263-1269
MissingFormLabel
- 31
Verdugo R J, Salinas R A, Castillo J L et al.
Surgical versus non-surgical treatment for carpal tunnel syndrome.
Cochrane Database Syst Rev.
2008;
4
CD001552
MissingFormLabel
- 32
Spinner R J.
Outcomes for peripheral nerve entrapment syndromes.
Clin Neurosurg.
2006;
53
285-294
MissingFormLabel
- 33
Tennent T D, Goddard N J.
Carpal tunnel decompression: open vs endoscopic.
Br J Hosp Med.
1997;
58
551-554
MissingFormLabel
- 34
Riew K D, Yin Y, Gilula L et al.
The effect of nerve-root injections on the need for operative treatment of lumbar
radicular pain. A prospective, randomized, controlled, double-blind study.
J Bone Joint Surg Am.
2000;
82-A
1589-1593
MissingFormLabel
- 35
Manchikanti L, Damron K, Cash K et al.
Therapeutic cervical medial branch blocks in managing chronic neck pain: a preliminary
report of a randomized, double-blind, controlled trial: clinical trial NCT0033272.
Pain Physician.
2006;
9
333-346
MissingFormLabel
- 36
Galiano K, Obwegeser A A, Bodner G et al.
Ultrasound guidance for facet joint injections in the lumbar spine: a computed tomography-controlled
feasibility study.
Anesth Analg.
2005;
101
579-583
, table of contents
MissingFormLabel
- 37
Galiano K, Obwegeser A A, Bale R et al.
Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections
in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic
pattern.
Reg Anesth Pain Med.
2007;
32
254-257
MissingFormLabel
- 38
Loizides A, Gruber H, Peer S et al.
A new simplified sonographic approach for pararadicular injections in the lumbar spine:
a CT-controlled cadaver study.
AJNR Am J Neuroradiol.
2011;
32
828-831
MissingFormLabel
- 39
Ewertsen C, Henriksen B M, Torp-Pedersen S et al.
Characterization by Biopsy or CEUS of Liver Lesions Guided by Image Fusion between
Ultrasonography and CT, PET/CT or MRI (Charakterisierung von Leberläsionen mittels
Biopsie oder CEUS anhand von Bildfusion zwischen Ultraschall und CT, PET/CT oder MRT).
Ultraschall in Med.
2011;
32
191-197
MissingFormLabel
Helmut Kopf
Institut für diagnostische und interventionelle Radiologie, Wilhelminenspital der
Stadt Wien
Montleartstrasse 37
1160 Wien
Österreich
Telefon: ++ 43/1/49 15 03 10 8
Fax: ++ 43/1/49 15 03 10 9
eMail: helmut.kopf@wienkav.at