Moderne neurochirurgische Behandlungsmöglichkeiten bei Schlaganfall

Zusammenfassung

Gegenstand: Trotz der Entwicklung moderner Präventions- und Therapieverfahren zählt der zerebrale Insult zu den häufigsten Erkrankungen und ist durch eine hohe Morbidität und Mortalität gekennzeichnet. Bei der Akuttherapie eines raumfordernden Hirninfarktes stellt eine frühzeitige Dekompressionskraniektomie eine wertvolle Therapieoption dar. Im Rahmen der Sekundärprophylaxe bei Gefäß-verschluss und zerebraler Minderperfusion kann der extra-intrakraniellen Bypass bei einem ausgesuchten Patientengut eine wichtige Stellung einnehmen. Material und Methoden: Im Folgenden werden hinsichtlich der Akuttherapie Indikationen, Zeitpunkt und Technik der Dekompressionskraniektomie erläutert. Des Weiteren wird die minimal-invasive Technik zur Anlage eines extra-intrakraniellen Bypasses vorgestellt. Ergebnisse: Bei einem raumfordernden Hirninfarkt führt die frühzeitige operative Dekompression neben einer deutlich reduzierten Mortalität zu einem verbesserten Funktionserhalt durch eine Verkleinerung des Infarktareals. Die Anlage eines extra-intrakraniellen Bypasses erlaubt bei einem streng selektionierten Patientengut eine signifikante Verbesserung der Hirnperfusion bei einer operativen Morbidität und Mortalität deutlich unter 5%. Schlussfolgerungen: Heutzutage tragen sowohl bei der Akuttherapie als auch bei der Sekundärprophylaxe neurochirurgische Therapiemöglichkeiten zur Verbesserung der funktionellen Ergebnisse bei zerebrovaskulären Erkrankungen bei. Von entscheidender Bedeutung sind moderne diagnostischen Möglichkeiten, verfeinerte chirurgische Techniken sowie der optimale Zeitpunkt der operativen Therapie.

Summary

Objective: Despite recent advances in the prevention and treatment, acute ischaemic stroke is one of the most frequent diseases in Germany and associated with high morbidity and mortality. Early surgical decompression is performed in acute ischaemic stroke with consecutive development of space-occupying cerebral infarction. For secondary prevention of an ischaemic stroke, extracranial-intracranial bypass surgery represents one important therapeutic option to be considered for selected cases. Material and methods: In regard to the surgical therapy of a space-occupying hemispheric infarction, the indication, optimal point of time and the technique of a correct hemispheric decompression is commented. Additionally, the standard microsurgical technique that is performed in extra-cranial-intracranial bypass surgery is illustrated. Results: In space-occupying cerebral infarction, early surgical decompression results in significantly reduced mortality and improves the functional outcome. For prevention, in accurately selected patients, extra-cranial-intracranial bypass surgery is associated with morbidity and mortality of less than 5%. Modern imaging techniques to monitor dynamic cerebral blood flow allow an evaluation of these patients. Conclusions: Today, neurosurgical therapeutic options play an important role in the therapy of acute space-occupying cerebral infarction and in the prevention of ischaemic stroke due to haemodynamic insufficiency.

Schlüsselwörter

Karotisstenose - extrakranieller-intrakranieller Bypass - Revaskularisation - minimal-invasive Technik - Dekompressionskraniektomie

Keywords

Carotid occlusion - extracranial-intracranial bypass - cerebral revascularization - minimal-invasive-surgical technique - decompressive craniectomy

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