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Neonatologie Scan 2022; 11(03): 211-228
DOI: 10.1055/a-1638-1947
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Neue neurochirurgische Therapieverfahren in der Neonatologie – Möglichkeiten und Voraussetzungen

Gesa Cohrs
,
Matthias Schulz
,
Ulrich-Wilhelm Thomale
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Die neurochirurgische Behandlung von Erkrankungen des zentralen Nervensystems in der Neonatalperiode stellt besondere Herausforderungen an das interdisziplinäre Team. Hierfür kommt der Neonatologie, der Kinderanästhesie und der Kinderneurochirurgie eine besondere Rolle zu. Das Verständnis der pathophysiologischen Grundlagen und eine entsprechende Expertise der zu behandelnden Pathologie tragen zum erfolgreichen Erreichen des Behandlungsziels bei.
Kernaussagen

  • Die Therapiealternativen des PHHC umfassen EVD, VAD, VSGS und NEL; das aktive Entfernen von Blutungsbestandteilen scheint im Vergleich zu herkömmlichen Verfahren günstige Effekte auf das Shunt-Management und das neurologische Outcome frühgeborener Patienten zu haben.

  • Insbesondere die Anwendung der NEL bei PHHC hat das Potenzial, die Notwendigkeit einer Shunt-Implantation zu verringern; zudem kann die Shunt-Therapie den weiteren Verlauf mit weniger Komplikationen erleichtern.

  • Die NEL kann im Rahmen der Behandlung des PIHC den Erreger- und Proteingehalt senken und die Entstehung eines MLHC verhindern.

  • Die Shunt-Therapie bei Früh- und Neugeborenen sollte auf eine physiologische Adaptation des Kopfumfanges abzielen, um Über- und Unterdrainage zu vermeiden, dieses kann mithilfe verstellbarer Differentialdruckventile inklusive gravitationsassistierter Einheiten erreicht werden.

  • Patienten mit komplexen Fehlbildungen des zentralen Nervensystems, wie Myelomeningozelen, benötigen eine umfassende interdisziplinäre perinatale Betreuung bei assoziiertem Hydrozephalus, Chiari-II-Malformation sowie orthopädischen und urologischen Fragestellungen. Die pränatale Versorgung dieser Patienten kann zur Verbesserung des Outcomes beitragen.

Schlüsselwörter

Neuroendoskopie - ventrikuloperitonealer Shunt - intraventrikuläre Hämorrhagie - Hydrozephalus


Publication History

Article published online:
19 August 2022

© 2022. Thieme. All rights reserved.

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