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DOI: 10.1055/a-1189-3627
Nervensonografie – eine neurologische Perspektive auf chirurgisch relevante Krankheitsbilder der peripheren Nerven
Peripheral Nerve Imaging – from a Neurological Perspective for SurgeonsZusammenfassung
Die Nervensonografie ist ein relativ neues und patientennahes Verfahren zur Visualisierung der peripheren Nerven von ihren distalen bis zu den proximalen Segmenten. Mithilfe dieser Methode gelingt die Auffindung und anatomisch genaue Lokalisation von peripher-nervalen Läsionen sowie deren ätiologische Zuordnung. Die Nervensonografie kann dabei nervale Engpasssyndrome und deren sekundäre Ursachen relativ sicher diagnostizieren. Auch operativ zu versorgende Faszikeltorsionen lassen sich mithilfe von Ultraschall nachweisen. Weitere Anwendungsgebiete eröffnen sich durch sonografisch geführte Interventionen am peripheren Nerven sowie im Rahmen der intraoperativen Anwendung als Navigationsverfahren. In der interdisziplinären Zusammenarbeit mit den chirurgischen Fachrichtungen liegt der Wert des Nervenultraschalls vor allem in der frühzeitigen Detektion von irreversiblen traumatischen Nervenschädigungen i. S. kompletter Nervendurchtrennungen, die eine frühzeitige operative Versorgung erforderlich machen. Für die neurologische Diagnostik relevant ist die Differenzierung zwischen verschiedenen Polyneuropathieformen. Der vorgelegte Übersichtsartikel soll eine Einführung in das Feld der Nervensonografie geben und die für die chirurgisch relevanten Krankheitsbilder des peripheren Nervensystems wesentlichen Ultraschallbefunde darstellen. Dieses neue bildgebende Verfahren wird zukünftig einer der Schlüssel für den Aufbau von interdisziplinären Kompetenzzentren zur Versorgung von Krankheitsbildern der peripheren Nerven sein.
Abstract
Nerve ultrasound is a fairly new non-invasive method to visualise peripheral nerves and to detect peripheral nerve lesions. This technique can depict nerve compression syndromes and their aetiologies as well as fascicular torsions. It is also suitable for sonographically guided nerve interventions and for intraoperative navigation. The main advantage of nerve ultrasound is its capability for early diagnosis of severe traumatic nerve lesions that require immediate surgery. Neurologists further use this method to aid the diagnosis of different kinds of polyneuropathies. Within this review we introduce nerve ultrasound to surgeons from a neurological perspective. We focus on different peripheral nerve disorders that might need surgical interventions. Nerve ultrasound will lay the grounds to bring together different expertise in medicine and thus to establish interdisciplinary excellence centres for the understanding, diagnosis and treatment of diseases of the peripheral nervous system.
Schlüsselwörter
Handchirurgie - bildgebende Verfahren - interdisziplinär - integrierte Versorgung - plastische Chirurgie - SonografieKey words
hand surgery - interdisciplinary - multidisciplinarity - plastic surgery - review/expertise - ultrasoundPublication History
Article published online:
02 July 2020
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Literatur
- 1 Cartwright MS, Baute V, Caress JB. et al. Ultrahigh-frequency ultrasound of fascicles in the median nerve at the wrist. Muscle Nerve 2017; 56: 819-822 doi:10.1002/mus.25617
- 2 Pham M. Methodik und was kann die MR-Neurografie – Diagnostic Value of MR Neurography. Klin Neurophysiol 2015; 46: 14-18 doi:10.1055/s-0034-1398611
- 3 Grimm A, Axer H, Heiling B. et al. Nerve ultrasound normal values – readjustment of the ultrasound pattern sum score UPSS. Clin Neurophysiol 2018; 129: 1403-1409 doi:10.1016/j.clinph.2018.03.036
- 4 Tawfik EA, Cartwright MS, Grimm A. et al. Guidelines for neuromuscular ultrasound training. Muscle Nerve 2019; 60: 361-366 doi:10.1002/mus.26642
- 5 Grimm A, Allendörfer J, Bischoff C. et al. Positionspapier der Deutschen Gesellschaft für klinische Neurophysiologie DGKN und der Deutschen Gesellschaft für Ultraschall in der Medizin DEGUM, Sektion Neurologie zur „Wertigkeit des Nerven- und Muskelultraschalls in der Diagnostik neuromuskulärer Erkrankungen“. Klin Neurophysiol 2018; 49: 236-237 doi:10.1055/a-0635-9584
- 6 Assmus H, Antoniadis G, Bischoff C. Carpal and cubital tunnel and other, rarer nerve compression syndromes. Dtsch Arztebl Int 2015; 112: 14-25 doi:10.3238/arztebl.2015.0014
- 7 Hobson-Webb LD, Massey JM, Juel VC. et al. The ultrasonographic wrist-to-forearm median nerve area ratio in carpal tunnel syndrome. Clin Neurophysiol 2008; 119: 1353-1357 doi:10.1016/j.clinph.2008.01.101
- 8 Gruber H, Glodny B, Peer S. The validity of ultrasonographic assessment in cubital tunnel syndrome: the value of a cubital-to-humeral nerve area ratio (CHR) combined with morphologic features. Ultrasound Med Biol 2010; 36: 376-382 doi:10.1016/j.ultrasmedbio.2009.09.008
- 9 Karahan AY, Arslan S, Ordahan B. et al. Superb microvascular imaging of the median nerve in carpal tunnel syndrome: an electrodiagnostic and ultrasonographic study. J Ultrasound Med 2018; 37: 2855-2861 doi:10.1002/jum.14645
- 10 Zaidman CM, Seelig MJ, Baker JC. et al. Detection of peripheral nerve pathology: comparison of ultrasound and MRI. Neurology 2013; 80: 1634-1640 doi:10.1212/WNL.0b013e3182904f3f
- 11 Presazzi A, Bortolotto C, Zacchino M. et al. Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. J Ultrasound 2011; 14: 40-46 doi:10.1016/j.jus.2011.01.006
- 12 Schelle T. Methodik und was kann die Nervensonografie. Klin Neurophysiol 2015; 46: 79-89 doi:10.1055/s-0035-1549945
- 13 Marquez Neto OR, Leite MS, Freitas T. et al. The role of magnetic resonance imaging in the evaluation of peripheral nerves following traumatic lesion: where do we stand?. Acta Neurochir (Wien) 2017; 159: 281-290 doi:10.1007/s00701-016-3055-2
- 14 Koenig RW, Pedro MT, Heinen CPG. et al. High-resolution ultrasonography in evaluating peripheral nerve entrapment and trauma. Neurosurg Focus 2009; 26: E13 doi:10.3171/FOC.2009.26.2.E13
- 15 Arányi Z, Csillik A, Dévay K. et al. Ultrasonographic identification of nerve pathology in neuralgic amyotrophy: enlargement, constriction, fascicular entwinement, and torsion. Muscle Nerve 2015; 52: 503-511 doi:10.1002/mus.24615
- 16 Arányi Z, Csillik A, Dévay K. et al. Ultrasonography in neuralgic amyotrophy: sensitivity, spectrum of findings, and clinical correlations. Muscle Nerve 2017; 56: 1054-1062 doi:10.1002/mus.25708
- 17 Loizides A, Baur E-M, Plaikner M. et al. Triple hourglass-like fascicular constriction of the posterior interosseous nerve: a rare cause of PIN syndrome. Arch Orthop Trauma Surg 2015; 135: 635-637 doi:10.1007/s00402-015-2177-y
- 18 Endo Y, Miller TT, Carlson E. et al. Spontaneous nerve torsion: unusual cause of radial nerve palsy. Skeletal Radiol 2015; 44: 457-461 doi:10.1007/s00256-014-2006-3
- 19 Kim DH, Sung DH, Chang MC. Diagnosis of hourglass-like constriction neuropathy of the radial nerve using high-resolution magnetic resonance neurography: a report of two cases. Diagnostics (Basel) 2020; 10: 232 doi:10.3390/diagnostics10040232
- 20 Kollmer J, Preisser P, Bendszus M. et al. Fascicular torsions of the anterior and posterior interosseous nerve in 4 cases: neuroimaging methods to improve diagnosis. J Neurosurg 2019; DOI: 10.3171/2019.3.JNS183302.
- 21 Qi HT, Wang XM, Li SY. et al. The role of ultrasonography and MRI in patients with non-traumatic nerve fascicle torsion of the upper extremity. Clin Radiol 2013; 68: e479-483 doi:10.1016/j.crad.2013.03.021
- 22 Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990; 13: 771-784 doi:10.1002/mus.880130903
- 23 Tagliafico A, Altafini L, Garello I. et al. Traumatic neuropathies: spectrum of imaging findings and postoperative assessment. Semin Musculoskelet Radiol 2010; 14: 512-522 doi:10.1055/s-0030-1268071
- 24 Zeidenberg J, Burks SS, Jose J. et al. The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases. Neurosurg Focus 2015; 39: E3 doi:10.3171/2015.6.FOCUS15214
- 25 Visalli C, Cavallaro M, Concerto A. et al. Ultrasonography of traumatic injuries to limb peripheral nerves: technical aspects and spectrum of features. Jpn J Radiol 2018; 36: 592-602 doi:10.1007/s11604-018-0765-9
- 26 Stefanou M-I, Schubert V, Ruschil C. et al. Median nerve dissection after brachial artery catheterization revealed by high-resolution ultrasound. Clin Neurophysiol 2019; 130: 1081-1082 doi:10.1016/j.clinph.2019.04.007
- 27 Koenig RW, Schmidt TE, Heinen CPG. et al. Intraoperative high-resolution ultrasound: a new technique in the management of peripheral nerve disorders. J Neurosurg 2011; 114: 514-521 doi:10.3171/2010.9.JNS10464
- 28 Pedro MT, Antoniadis G, Scheuerle A. et al. Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions. Neurosurg Focus 2015; 39: E5 doi:10.3171/2015.6.FOCUS15218
- 29 Winter N, Rattay TW, Axer H. et al. Ultrasound assessment of peripheral nerve pathology in neurofibromatosis type 1 and 2. Clin Neurophysiol 2017; 128: 702-706 doi:10.1016/j.clinph.2017.02.005
- 30 Grimm A, Vittore D, Schubert V. et al. Ultrasound pattern sum score, homogeneity score and regional nerve enlargement index for differentiation of demyelinating inflammatory and hereditary neuropathies. Clin Neurophysiol 2016; 127: 2618-2624 doi:10.1016/j.clinph.2016.04.009
- 31 Schreiber S, Oldag A, Kornblum C. et al. Sonography of the median nerve in CMT1A, CMT2A, CMTX, and HNPP. Muscle Nerve 2013; 47: 385-395 doi:10.1002/mus.23681
- 32 Podnar S, Sarafov S, Tournev I. et al. Peripheral nerve ultrasonography in patients with transthyretin amyloidosis. Clin Neurophysiol 2017; 128: 505-511 doi:10.1016/j.clinph.2017.01.013
- 33 Kerasnoudis A, Pitarokoili K, Haghikia A. et al. Nerve ultrasound protocol in differentiating chronic immune-mediated neuropathies. Muscle Nerve 2016; 54: 864-871 doi:10.1002/mus.25138
- 34 Grimm A, Oertl H, Auffenberg E. et al. Differentiation between Guillain-Barré syndrome and acute-onset chronic inflammatory demyelinating polyradiculoneuritis-a prospective follow-up study using ultrasound and neurophysiological measurements. Neurotherapeutics 2019; 16: 838-847 doi:10.1007/s13311-019-00716-5
- 35 Grimm A, Décard BF, Axer H. et al. The ultrasound pattern sum score – UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol 2015; 126: 2216-2225 doi:10.1016/j.clinph.2015.01.011
- 36 Grimm A, Decard BF, Athanasopoulou I. et al. Nerve ultrasound for differentiation between amyotrophic lateral sclerosis and multifocal motor neuropathy. J Neurol 2015; 262: 870-880 doi:10.1007/s00415-015-7648-0
- 37 Härtig F, Ross M, Dammeier NM. et al. Nerve ultrasound predicts treatment response in chronic inflammatory demyelinating polyradiculoneuropathy-a prospective follow-up. Neurotherapeutics 2018; 15: 439-451 doi:10.1007/s13311-018-0609-4
- 38 Schreiber S, Abdulla S, Debska-Vielhaber G. et al. Peripheral nerve ultrasound in amyotrophic lateral sclerosis phenotypes. Muscle Nerve 2015; 51: 669-675 doi:10.1002/mus.24431
- 39 Pelosi L, Mulroy E, Rodrigues MJ. et al. Neuronopathy and neuropathy in autosomal dominant spino-cerebellar ataxia (SCA): a preliminary peripheral nerve ultrasound study. Clin Neurophysiol 2017; 128: 2436-2437 doi:10.1016/j.clinph.2017.09.114