Innovationen im Neuromonitoring mit Ultraschall^[*]

Zusammenfassung

Schwerpunkt dieses Übersichtsartikels sind Ultraschall-Verfahren, die ein Neuromonitoring durch Erfassung der Morphologie von Hirnstrukturen und zerebralem Blutfluss im Verlauf ermöglichen. Einige Techniken sind momentan Randgebiete der Ultraschalldiagnostik. Ihr großer Vorteil ist die Nichtinvasivität und die Untersuchung am Patientenbett. Dadurch können Zeit, Kosten und Nebenwirkungen durch Vermeidung von Transporten akut kranker Patienten zum CT oder MRT gespart werden. Eine Abschätzung des Hirndrucks gelingt so z. B. durch die mehrzeitige Bestimmung des Pulsatilitätsindex, des zerebralen venösen Blutflusses, die Mittellinienverlagerung und die transorbitale Sonografie der Optikusscheiden. Der transkranielle Ultraschall kann ferner zur Darstellung zerebraler Blutungen und zur Unterstützung bei neurochirurgischen Eingriffen dienen. Zuletzt berichten wir über den Nutzen der Bestimmung der zerebralen Autoregulation und den aktuellen Stand zur Sonothrombolyse bei Arterienverschlüssen.

Abstract

This review describes transcranial ultrasound-based neuromonitoring by assessing changes of brain structures or cerebral blood flow over time. Some of the presented ultrasound techniques are still experimental. They are advantageous as they provide non-invasive and bed-side imaging. Thus, time, costs and potentially hazardous side effects due to transportation of acutely ill patients to CT or MRI scanners can be avoided. An assessment of increased cerebral pressure can be achieved by repeated determination of individual pulsatility index, cerebral venous blood flow, midline shift and transorbital optic sheath measurements. Moreover, transcranial duplex sonography offers the possibility to detect intracranial haemorrhage and to guide neurosurgical interventions. Finally, the value of measuring cerebral autoregulation and the current state of the art regarding sonothrombolysis in acute intracranial arterial thrombosis is presented.

Schlüsselwörter

Neuromonitoring - transkranieller Ultraschall - Hirndruck - zerebrale Autoregulation - Sonothrombolyse

Key words

neuromonitoring - transcranial ultrasound - elevated intracranial pressure - cerebral autoregulation - sonothrombolysis

^* Erstveröffentlichung in Klin Neurophysiol 2011; 42: e1–e12.

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