Zusammenfassung
Die Behandlungsnotwendigkeit von Säuglingshämangiomen wurde lange Zeit kontrovers
diskutiert. Dies lag im Wesentlichen an der Beobachtung der Involution und somit der
potenziellen, fast vollständigen Rückbildungspotenz ohne medizinische Maßnahmen und
deren Risiken. Auf der anderen Seite standen die Verläufe mit einem rasanten Wachstum
initial kleiner Hämangiome mit Beeinträchtigung oder Verlust wichtiger Funktionen
(Bsp. Visusverlust bei periokulärer Lokalisation). Erschwerend kam hinzu, dass eine
Vielzahl von Klassifikationen verwendet wurden, welche eine Vergleichbarkeit der Ergebnisse
schwierig bis unmöglich machte. Aus diesem Grunde werden in dieser Arbeit die typischen
(klassischen) Säuglingshämangiome von den übrigen Formen abgegrenzt. Das Hauptziel
ist der Wachstumsstopp bzw. die Rückbildung bis zur alleinigen kosmetischen Beeinträchtigung.
Jede drohende Funktionsbeeinträchtigung ist als dringliche Behandlungsnotwendigkeit
anzusehen. In der Übersicht der möglichen Therapieoptionen und ihrer Einschätzung
zu Verbreitung und aktuellen Wertigkeit sind 1. die Kryotherapie oder 2. die Lasertherapie
bei lokalisierten Formen aufgrund ihrer gesicherten Datenlage zu favorisieren. Bei
lokal schlecht behandelbaren Formen ist mit Propanolol ein neues Medikament für die
Indikation in der Erprobung. Hier stehen jedoch die Daten zur sicheren Beurteilung
noch aus.
Abstract
The necessity of haemangioma treatment in infants has been controversially discussed
for years. One reason is the favoured clinical observation of a potential spontaneous
involution without any therapeutic approach or medical treatment, thus avoiding their
specific risks. On the other hand, there are several reports on serious cases with
rapidly growing haemangiomas including severe consequences. There are potential complications
such as loss of visus in cases of periorbital manifestation. A basic problem is the
lack of a unique systematic classification, on the basis of which diagnostic measures,
therapeutic indications and modes could be compared. Such a classification would be
much more competent including a sufficient comparison of treatment results. The basic
aim in management is to achieve control of the haemangioma growth and induction of
its subsequent involution back to only a cosmetic detraction. Each threatening functional
loss can be classified as an urgent indication for treatment. There is a need to consider
the treatment options and their values; in particular, cryotherapy or laser therapy
in localised manifestations are mostly favoured because of the convincing evidence
from available data. In the case of a more disseminated haemangioma manifestation,
the initiation of propranol medication is possible, a novel drug for this indication.
However, there are no follow-up data on the mid-term or long-term outcome available
at this time. Further studies on the subject are therefore required.
Schlüsselwörter
Hämangiom - Klassifikation - Therapie
Key words
haemangioma - classification - treatment
Literatur
- 1
Mulliken J B, Glowacki J.
Hemangiomas and vascular malformations in infants and children: a classification based
on endothelial characteristics.
Plast Reconstr Surg.
1982;
69
412-422
- 2
Landthaler M, Hohenleutner U.
Classification of vascular abnormalities and neoplasms.
Hautarzt.
1997;
48
622-628
- 3
Cremer H.
Hämangiome (vaskuläre Tumoren) – neue Klassifizierung.
Kinder- und Jugendarzt.
2008;
39
623-633
- 4
Boon L M, Enjolras O, Mulliken J B.
Congenital hemangioma: evidence of accelerated involution.
J Pediatr.
1996;
128
329-335
- 5
Cremer H.
Cryosurgery for hemangiomas.
Pediatr Dermatol.
1998;
15
410-421
- 6
Achauer B M, van der Kam V C.
Capillary hemangioma (strawberry mark) of infancy: comparison of argon and Nd:YAG
laser treatment.
Plast Reconstr Surg.
1989;
84
60-69
- 7
Scheepers J H, Quaba A A.
Does the pulsed tunable dye laser have a role in the management of infantile hemangiomas?
Observations based on 3 years‘ experience.
Plast Reconstr Surg.
1995;
95
305-312
- 8
Poetke M, Philipp C, Berlien H P.
Flashlamp-pumped pulsed dye laser for hemangiomas in infancy: treatment of superficial
vs mixed hemangiomas.
Arch Dermatol.
2000;
136
628-632
- 9
Werner J A, Lippert B M, Godbersen G S et al.
Treatment of hemangioma with the neodymium:yttrium-aluminum-garnet laser (Nd:YAG laser).
Laryngorhinootologie.
1992;
71
388-395
- 10
Vlachakis I, Gardikis S, Michailoudi E et al.
Treatment of hemangiomas in children using a Nd:YAG laser in conjunction with ice
cooling of the epidermis: techniques and results.
BMC Pediatr.
2003;
3
2-5
- 11
Clymer M A, Fortune D S, Reinisch L et al.
Interstitial Nd:YAG photocoagulation for vascular malformations and hemangiomas in
childhood.
Arch Otolaryngol Head Neck Surg.
1998;
124
431-436
- 12
Lahl W, Hofmann B, Jelonek M et al.
Die endovenöse Lasertherapie der Varicosis – echte Innovation oder teure Spielerei.
Zentralbl Chir.
2006;
131
45-50
- 13
Pohl B.
Anästhesiologische Aspekte bei der Versorgung von Kindern in „nicht spezialisierten
Abteilungen“.
Zentralbl Chir.
2008;
133
539-542
- 14
Fu C H, Lee L A, Fang T J et al.
Endoscopic Nd:YAG laser therapy of infantile subglottic hemangioma.
Pediatr Pulmonol.
2007;
42
89-92
- 15
Raulin C, Hellwig S, Schonermark M P.
Treatment of a nonresponding port-wine stain with a new pulsed light source (PhotoDerm
VL).
Lasers Surg Med.
1997;
21
203-208
- 16
Sanchez C I, Mihm M C, Waner M.
Laser and intense pulsed light in the treatment of infantile haemangiomas and vascular
malformations.
An Sist Sanit Navar.
2004;
27 Suppl 1
103-115
- 17
Andrews G C, Kelly R J.
Treatment of vascular nevi by injection of sclerosing solutions.
Arch Derm Syphilol.
1932;
26
92-94
- 18
Hommer K, Betelheim H.
Zentralarterienverschluß nach Injektion in die Haut der Nase und der Stirne.
Wien Klin Wochenschr.
1978;
90
777-779
- 19
Kurokawa T, Hattori T, Furue H.
Clinical experiences with the streptococcal anticancer preparation, OK-432 (NSC-B116209).
Cancer Chemother Rep.
1972;
56
211-220
- 20
Kimura I, Ohnoshi T, Nakata Y et al.
Immuno-chemotherapy of malignant lymphoma using OK-432, a streptococcal agent.
Acta Med Okayama.
1979;
33
471-478
- 21
Ogita S, Tsuto T, Tokiwa K et al.
Intracystic injection of OK-432: a new sclerosing therapy for cystic hygroma in children.
Br J Surg.
1987;
74
690-691
- 22
Ogita S, Tsuto T, Deguchi E et al.
Giant cavernous haemangioma: treatment with intralesional injection of OK-432.
Z Kinderchir.
1988;
43
408-409
- 23
Payr E.
Beiträge zur Technik der Blutgefäss- und Nervennaht nebst Mittheilungen über die Verwendung
eines resorbirbaren Metalles in der Chirurgie.
Arch Klin Chir.
1900;
62
67-82
- 24
Payr E.
Ueber Verwendung von Magnesium zur Behandlung von Blutgefässerkrankungen.
Langenbecks Arch Surg.
1902;
63
503-511
- 25
Staindl O.
Hemangiomas of the lips: treatment with magnesium seeds.
Facial Plast Surg.
1990;
7
114-118
- 26
Walter C.
The treatment of hemangioma with fibrin glue.
Facial Plast Surg.
1985;
2
357-362
- 27
Tonner P H, Scholz J.
Possible lung embolism following embolization of a hemangioma with fibrin glue.
Anaesthesist.
1994;
43
614-617
- 28
Yang Y, Sun M, Hou R et al.
Preliminary study of fibrin glue combined with pingyangmycin for the treatment of
venous malformations in the oral and maxillofacial region.
J Oral Maxillofac Surg.
2008;
66
2219-2225
- 29
Mazoyer J F, Lapray J F, Pialat J et al.
Embolization with isobutyl-cyanoacrylate. Preliminary experimental results (author‘s
transl).
Ann Radiol.
1980;
23
359-361
- 30
Horak D, Svec F, Isakov Y et al.
Use of poly(2-hydroxyethyl methacrylate) for endovascular occlusion in pediatric surgery.
Clin Mater.
1992;
9
43-48
- 31
Elsas F J, Lewis A R.
Topical treatment of periocular capillary hemangioma.
J Pediatr Ophthalmol Strabismus.
1994;
31
153-156
- 32
Garzon M C, Lucky A W, Hawrot A et al.
Ultrapotent topical corticosteroid treatment of hemangiomas of infancy.
J Am Acad Dermatol.
2005;
52
281-286
- 33
Sloan G M, Reinisch J F, Nichter L S et al.
Intralesional corticosteroid therapy for infantile hemangiomas.
Plast Reconstr Surg.
1989;
83
459-467
- 34
Sutula F C, Glover A T.
Eyelid necrosis following intralesional corticosteroid injection for capillary hemangioma.
Ophthalmic Surg.
1987;
18
103-105
- 35
Chantharatanapiboon W.
Intralesional corticosteroid therapy in hemangiomas: clinical outcome in 160 cases.
J Med Assoc Thai.
2008;
91 Suppl 3
S 90-S 96
- 36
Berman B, Poochareon V N, Villa A M.
Novel dermatologic uses of the immune response modifier imiquimod 5 % cream.
Skin Therapy Lett.
2002;
7
1-6
- 37
Hazen P G, Carney J F, Engstrom C W et al.
Proliferating hemangioma of infancy: successful treatment with topical 5 % imiquimod
cream.
Pediatr Dermatol.
2005;
22
254-256
- 38
Li V W, Li W W, Talcott K E et al.
Imiquimod as an antiangiogenic agent.
J Drugs Dermatol.
2005;
4
708-717
- 39
McCuaig C C, Dubois J, Powell J et al.
A phase II, open-label study of the efficacy and safety of imiquimod in the treatment
of superficial and mixed infantile hemangioma.
Pediatr Dermatol.
2009;
26
203-212
- 40
Hussain W, Judge M R.
The role of imiquimod in treating infantile haemangiomas: cause for concern?.
Clin Exp Dermatol.
2009;
34
e257
- 41
Pandey A, Gangopadhyay A N, Gopal S C et al.
Twenty years‘ experience of steroids in infantile hemangioma – a developing country‘s
perspective.
J Pediatr Surg.
2009;
44
688-694
- 42
Zarem H A, Edgerton M T.
Induced resolution of cavernous hemangiomas following prednisolone therapy.
Plast Reconstr Surg.
1967;
39
76-83
- 43
Greene A K.
Corticosteroid treatment for problematic infantile hemangioma: evidence does not support
an increased risk for cerebral palsy.
Pediatrics.
2008;
121
1251-1252
- 44
Wu G, Jones J, Sequeira I B et al.
Congenital pericardial hemangioma responding to high-dose corticosteroid therapy.
Can J Cardiol.
2009;
25
e139-e140
- 45
Rios A, Mansell P W, Newell G R et al.
Treatment of acquired immunodeficiency syndrome – related Kaposi‘s sarcoma with lymphoblastoid
interferon.
J Clin Oncol.
1985;
3
506-512
- 46
Ricketts R R, Hatley R M, Corden B J et al.
Interferon-alpha-2a for the treatment of complex hemangiomas of infancy and childhood.
Ann Surg.
1994;
219
605-612
- 47
Chao Y H, Liang D C, Chen S H et al.
Interferon-alpha for alarming hemangiomas in infants: experience of a single institution.
Pediatr Int.
2009;
51
469-473
- 48
Hoyoux C.
Vincristine treatment for management of alarming hemangiomas in infancy.
Rev Med Liege.
2008;
63
14-17
- 49
Hara K, Yoshida T, Kajiume T et al.
Successful treatment of Kasabach-Merritt syndrome with vincristine and diagnosis of
the hemangioma using three-dimensional imaging.
Pediatr Hematol Oncol.
2009;
26
375-380
- 50
Gottschling S, Schneider G, Meyer S et al.
Two infants with life-threatening diffuse neonatal hemangiomatosis treated with cyclophosphamide.
Pediatr Blood Cancer.
2006;
46
239-242
- 51
Leaute-Labreze C, Dumas de la R E, Hubiche T et al.
Propranolol for severe hemangiomas of infancy.
N Engl J Med.
2008;
358
2649-2651
- 52
Sanchez P R, Cortes M P, Gonzalez Rodriguez J D et al.
Treatment of infantile hemangioma with propranolol.
An Pediatr.
2009;
DOI: 10.1016/j.anpedi.2009.05.019
- 53
von Oeynhausen R-A.
Moderne Behandlung von Hämangiomen.
Langenbeck Arch Surg.
1965;
260
205-220
- 54 Asmussen P D, Söllner B. Indikationen und Kontraindakationen für die Kompressionstherapie. In:
Kompressionstherapie Prinzipien und Praxis. 1. Auflage ed. München: Elsevier GmbH,
Urban & Fischer; 2004: 101–105
- 55
Weiss E, Sukal S A, Zimbler M S et al.
Basal cell carcinoma arising 57 years after interstitial radiotherapy of a nasal hemangioma.
Dermatol Surg.
2008;
34
1137-1140
- 56
Furst C J, Lundell M, Holm L E.
Radiation therapy of hemangiomas, 1909–1959. A cohort based on 50 years of clinical
practice at Radiumhemmet, Stockholm.
Acta Oncol.
1987;
26
33-36
- 57
Panizzon R G.
Dermatologic radiotherapy.
Hautarzt.
2007;
58
701-710
- 58
Ogino I, Torikai K, Kobayasi S et al.
Therapy for life- or function-threatening infant hemangioma.
Radiology.
2001;
218
834-839
Dr. H. Krause
Universitätsklinikum Magdeburg AöR· Arbeitsbereich Kinderchirurgie · Klinik für Allgemein-,
Viszeral- und Gefäßchirurgie
Leipziger Straße 44
39120 Magdeburg
Deutschland
Telefon: 00 49 / 3 91 / 6 71 55 13
Fax: 00 49 / 3 91 / 6 71 55 82
eMail: hardy.krause@med.ovgu.de
