Ultraschallgezielte Interventionen an peripheren Nerven: diagnostische und therapeutische Indikationen

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.

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