Glasklare Nerven

Ein neuer Meilenstein in der Untersuchung von peripheren Nerven ist gelegt.

Durch die Methode der hochauflösenden Nervensonographie gelingt es schnell zuverlässig und kostengünstig, Erkrankungen in diesem Bereich festzustellen.  Der Vorteil der unkomplizierten raschen Verfügbarkeit dieser Methode ist für die Praxis nicht mehr fortzudenken. Für die Patienten ergeben sich zuverlässige Diagnosen auch in schwierigen Situationen, wo die bisherigen Methoden versagen mussten. Allein die Tatsache, dass Nervenstrukturen im Bereich von unterhalb 1 mm noch zuverlässig dargestellt werden können, ist eine revolutionäre Entwicklung.

Die Methode wird bisher nur von wenigen entsprechend ausgebildeten Spezialisten zuverlässig durchgeführt, nicht zuletzt wird eine kostenintensive Ausstattung mit speziellen Ultraschallgeräten und Sonden benötigt.

Allgemeinverständliche Hinweise zu diesem Thema gibt Dr. Josef Böhm in seinem folgenden Beitrag.

„Zitat“

Nerven werden sichtbar

Freiberger Klinik für Neurologie ermöglicht Blicke in feinste Strukturen der Nerven

Freiberg. Wenn Nerven beschädigt oder entzündet sind, können ganze Muskelgruppen nicht mehr funktionieren. „Das kann beispielsweise nach Brüchen passieren, wenn in der Nähe liegende Nerven in Mitleidenschaft gezogen wurden, oder im Handgelenk, wo die Nerven durch einen engen Bindegewebstunnel (Karpaltunnel) laufen. Dieser Tunnel kann im Alter oft zu einer Quetschung der Handnerven führen. Derartig feine Nerven konnten mit bisherigen Untersuchungsmethoden nicht ohne Weiteres sichtbar gemacht werden“, informiert Dr. Josef Böhm, Spezialist für Nervensonografie am Kreiskrankenhaus Freiberg. Ortung und Erkennung der Schäden seien aber Voraussetzung für eine zielgerichtete Behandlung und Heilung.

Die Nervensonografie ist eine junge Untersuchungsmethode für oberflächlich liegende Nerven, die mit Ultraschall arbeitet. Damit können zahlreiche Informationen über die verschiedensten Erkrankungen der Nerven gewonnen werden, ohne Eingriffe in den Körper des Patienten vornehmen zu müssen. Böhm nennt das Beispiel der Elektromyografie. Hierbei leiten in die Haut gestochene Nadelelektroden Potenzial-Schwankungen ab. Außerdem gebe es die Elektro-Neurografie, die die Nervenleitgeschwindigkeit bestimme. Aussagen über die Funktionsstörungen eines Nervs seien damit aber nicht möglich. Mit der Nervensonografie könne jetzt die Struktur im Detail dargestellt werden. Schlussfolgerungen auf die zu Grunde liegende Erkrankung seien möglich, erklärt der Spezialist. Das könnten beispielsweise Quetschungen, Tumore, Verletzungen oder entzündliche Verdickungen des Nervs sein. In der Klinik für Neurologie des Kreiskrankenhauses Freiberg sind nunmehr routinemäßige Diagnosen möglich. Besonders vorteilhaft bei der Ursachenforschung ist die Möglichkeit, den Nerv in seinem gesamten Verlauf darzustellen, um dadurch eine Auswahl des operativen Verfahrens zu ermöglichen. Für die erfolgreiche Untersuchung benötigt man nach Angaben des Arztes neben einer hochauflösenden Ultraschallsonde einen speziellen Computer nebst Bildschirm. Darüber hinaus sei die entsprechende Erfahrung des untersuchenden Arztes erforderlich.

„Ein peripherer Nerv ist mit einem Elektrokabel vergleichbar, das die Signale zwischen Gehirn, Rückenmark und den Muskeln, den inneren Organen oder der Haut hin und zurück befördert“, erklärt der Freiberger Neurologe. Am häufigsten habe er mit Kompressionssyndromen zu tun, bei denen es zu Druckschädigungen der Nerven kommt. Diese sind besonders an anatomischen Engstellen wie dem Handgelenk oder Ellenbogen zu finden. Weitere Erkrankungen, die durch die Nervensonografie besser diagnostiziert werden können, sind unklare Schmerz-Syndrome, anatomische Veränderungen an Nerven, Muskeln und Gefäßen oder Sehnenscheidenentzündungen.

Für die Nervensonografie wird im Kreiskrankenhaus Freiberg ein sehr leistungsfähiges Ultraschallgerät mit einer speziellen, hochauflösenden Sonde verwendet. Die Untersuchung dauert nach dem Erfassen der Patientengeschichte in Abhängigkeit vom Beschwerdebild etwa 15 Minuten und verursacht keinerlei Schmerzen. Der Arzt benutzt ein Kontaktgel auf dem Schallkopf. Das Gel verhindert, dass während der Untersuchung Luft zwischen Schallkopf und Körpergewebe gelangt und die Untersuchung stört.

Leider ist die Nervensonografie trotz mehrerer Bemühungen sei- tens der Ärzte noch keine Kassenleistung, sie muss demnach laut Gebührenordnung der Ärzte privat abgerechnet werden. Mittels Magnetresonanztomografie (MRT) sei laut Dr. Böhm eine Nervendarstellung zwar ebenfalls möglich, diese habe aber Nachteile, zum Beispiel den hohen Zeitaufwand und eine ungenauere Bildauflösung.

„Die Nutzung des Ultraschalls für die medizinische Diagnostik der Nerven hat sich als sehr effektiv und vor allem schmerzlos herausgestellt“, weiß der Neurologe. Die Geräte erzeugen den Ultraschall mithilfe elektrischer Kristalle, die beim Anlegen einer elektrischen Wechselspannung im Rhythmus dieser Spannung schwingen. Ihre Schwingungen verlassen als Ultraschall den Schallkopf des Geräts und dringen über das Kopplungsgel in den Körper ein. Der Schallkopf ist aber nicht nur Sender, sondern auch Empfänger von Schallwellen. Setzt der Arzt den Schallkopf zum Beispiel auf das Handgelenk des Patienten auf, sendet dieser die Ultraschallwellen in den Bereich des Karpaltunnels mit den darin befindlichen Nerven. Dort treffen die Wellen auf die verschiedenen Nervenstrukturen und werden unterschiedlich zum Schallkopf reflektiert. Der leitet die Daten an den Computer weiter, der die Informationen in Bilder umwandelt.

Die Sektion Neurologie der deutschen Gesellschaft für Ultraschall in der Medizin bietet zertifizierte Fortbildungskurse für die Nervensonografie an. Josef Böhm hat bereits viele Ärzte auf diesem Gebiet ausgebildet.

Service:

Informationen über die Nervensonografie erhält man im Kreiskrankenhaus Freiberg, Telefon 03731 772600 sowie bei der deutschen Gesellschaft für Ultraschall in der Medizin.

Mehr Informationen dazu:

www.kkh-freiberg.de

www.degum.de

Ultraschall anfangs nur militärisch genutzt

Der Grundgedanke der Sichtbarmachung von Strukturen durch Schall geht auf militärische Anwendungen zurück. Während des Ersten Weltkrieges übertrug der Franzose Paul Langevin mittels Quarzkristallen erzeugte Ultraschallwellen ins Wasser und entwickelte so ein Verfahren zur Ortung von Unterseebooten. Eine erste medizinische Anwendung erfolgte 1942 durch den Neurologen Karl Dussik, der einen Seitenventrikel des Großhirns darstellte. Er nannte sein Verfahren Hyperfonografie.

Seit dem Ende der 1940er-Jahre entwickelte sich die Sonografie gleichzeitig innerhalb verschiedener medizinischer Fachrichtungen. Es gab erste kardiologische Untersuchungen. Etwa gleichzeitig wurden erste Schnittbilder aus dem Bereich des Halses und des Bauches erzeugt. Dazu kreiste der Schallknopf um einen mit Wasser gefüllten Behälter, in dem der Patient saß. Eine erste Anwendung des Dopplerprinzips erfolgte 1959 durch den Japaner Shigeo Satomura, das sich schnell einen Platz in der Gefäß- und der Herzheilkunde erschloss. Farbkodierte Dopplerdarstellungen waren jedoch erst seit den 1980er-Jahren mit der Verfügbarkeit leistungsstarker Rechner möglich. (fp)

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