Zusammenfassung
Während leichte Verletzungen peripherer Nerven lediglich zu einer umschriebenen Schädigung der Markscheiden führen, die spätestens in 3 Monaten völlig ausheilt, kommt es nach eingreifenden Verletzungen zu einem Untergang der distalen Axonfragmente (Waller-Degeneration) und gleichzeitig auch zu zeitabhängigen Veränderungen in den Erfolgsorganen, in den Perikarya in Rückenmark und Spinalganglien und auch im Gehirn. Tierexperimentelle Studien und ebenso Befunde beim Menschen belegen, dass die Bedingungen für eine Regeneration der Nervenfasern in den ersten Tagen und Wochen nach der Verletzung am günstigsten sind. Deshalb ist zur optimalen Therapie geboten, möglichst früh zu klären, ob eine Chance zur Reinnervation unter ausschließlich konservativer Therapie besteht oder ob wegen der Schwere der Strukturschädigung eine operative Rekonstruktion erforderlich ist. Bildgebende Untersuchungsverfahren (Neurosonographie und Magnetresonanzneurographie) können die hierfür entscheidenden Informationen liefern. In der Regel sollte die Entscheidung über die Indikation zu einer Nervenoperation innerhalb von 3 Monaten getroffen werden. Auch bei optimaler Therapie ist der Heilverlauf schwerer Nervenverletzungen oft unbefriedigend. Seit einigen Jahren werden im Tierexperiment neuartige Verfahren zur Verbesserung der Nervenregeneration geprüft, die an ganz unterschiedlichen Punkten des Heilungsprozesses ansetzen. Es ist zu hoffen, dass sich hieraus in absehbarer Zeit auch Verfahren zur Verbesserung der Versorgung von Nervenverletzungen beim Menschen entwickeln lassen.
Summary
Whereas minor injuries to peripheral nerves merely lead to a circumscribed damage of the myelin sheath which is completely healed within 3 months, penetrating injuries lead to degeneration of the distal axonal fragment (Waller degeneration) and simultaneously to time-dependent alterations in the effector organs, in the perikarya in the medulla and spinal ganglia as well as in the brain. Animal experimental studies and also findings in humans confirm that the conditions for regeneration of nerve fibers are most favorable in the first days and weeks following injury. Therefore, for optimal therapy it should be clarified as early as possible whether there is a chance for reinnervation using exclusively conservative therapy or whether an operative reconstruction is necessary due to the severity of structural damage. Imaging investigation procedures, such as neurosonography and magnetic resonance (MR) neurography can provide decisive information on this aspect. As a rule, the decision on the indications for a nerve operation should be made within the first 3 months. Even with optimal therapy the healing process of severe neural injuries is often unsatisfactory. For some years novel procedures for improvement of nerve regeneration have been tested in animal experiments which involve totally different points in the healing process. It is hoped that with these approaches procedures for improvement in the treatment of nerve injuries in humans can be developed in the near future.
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Interessenkonflikt. H. Müller-Vahl gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Müller-Vahl, H. Traumatische Nervenschäden. Nervenarzt 86, 142–150 (2015). https://doi.org/10.1007/s00115-014-4124-5
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DOI: https://doi.org/10.1007/s00115-014-4124-5