Dokument: Sklerosierung von perimandibulären venösen vaskulären Malformationen
| Titel: | Sklerosierung von perimandibulären venösen vaskulären Malformationen | |||||||
| Weiterer Titel: | Sclerotherapy of perimandibular venous vascular malformations | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=65902 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20240524-155001-4 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Chapot, Marie Thea Jeanne [Autor] | |||||||
| Dateien: |
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| Beitragende: | Dr. Turowski, Bernd [Gutachter] Prof. Dr. med. Dr. med. dent. Rana, Majeed [Gutachter] | |||||||
| Stichwörter: | Sklerotherapie, Venöse vaskuläre Malformation, VVM | |||||||
| Dokumententyp (erweitert): | Dissertation | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Einleitung. Venöse vaskuläre Malformationen (VVM) sind angeborene Gefäßmalformationen. Sie zählen zu den häufigsten vaskulären Malformationen und kennzeichnen sich durch bläuliche Schwellungen in variabler Größe. Diese sind bei der Palpation weich, komprimierbar, pulsieren nicht und dehnen sich bei venöser Druckerhöhung (zum Beispiel Kopftieflage) aus. Die Lage ist ubiquitär, dennoch besonders häufig im Kopf-Hals-Bereich. VVM werden durch Sklerotherapie, Chirurgie, Laser oder durch eine Kombination dessen behandelt.
Ziel der Arbeit. Die Therapie der VVMs in der Mandibularegion durch Sklerotherapie wurde evaluiert. Die Effizienz der Behandlung wurde primär anhand der Reduktion der Symptomatik bemessen. Zusätzlich wurden als weitere sekundäre Kriterien die Größenreduktion und Reduktion der Signalintensität in der T2-Sequenz hinzugezogen. Die Komplikationen der angewandten Sklerosierungsmittel wurde evaluiert. Material und Methoden. 82 Patienten des Klinikums der Heinrich-Heine-Universität Düsseldorf und des Alfried-Krupp-Krankenhauses Essen wurden über einen Zeitraum von 15 Jahren retrospektiv eingeschlossen. Es wurde mit 5 verschiedenen Sklerosierungsmitteln: Bleomycin, Ethanol, Äthoxysklerol, Fibrovein und Picibanil behandelt. Die klinischen Symptome und die Bildgebung durch Magnetresonanztomografie wurden vor und nach Sklerotherapie evaluiert. Der klinische Therapieerfolg wurde in 3 Kategorien eingeteilt: 1) klinisch symptomfrei 2) Besserung der Symptomatik 3) keine Änderung oder Verschlechterung. Anhand von MR Bildgebung vor und nach Behandlung im Verlauf wurden Größe und Signalintensität bemessen. Ergebnisse. Es wurden insgesamt 540 Sklerosierungen (median 4), 166 mit Fibrovein, 209 mit Bleomycin, 94 mit Ethanol, 51 mit Äthoxysklerol und 20 mit Picibanil durchgeführt. 47 Patienten waren anschließend beschwerdefrei (57%), 32 mit reduzierten Symptomen (39%) und bei 3 Patienten (4%) waren die Symptome unverändert. Die Volumenreduktion auf der MRT war bei 27 Patienten >75%, zwischen 50-75% bei 21 Patienten, 25-50% bei 13 Patienten und bei 21 Patienten <25%. Eine Reduktion der Hyperintensität des Signals bei der T2 Bildgebung betrug bei 4 Patienten mehr als 75%, 40 Patienten 50-75%, 23 Patienten 50%, 12 Patienten 25-50% und bei 3 Patienten >25%. Klinisch relevante Komplikationen sind bei einem Patienten nach Sklerosierung mit Ethanol eingetreten. Schlussfolgerung. Die Sklerosierung von venösen Malformationen ist eine von den Patienten gut tolerierte und effektive Therapie. In dieser retrospektiven Bewertung nach 540 Sklerotherapien ist ein positives Ergebnis in 89% der Fälle erreicht worden. Die Ausdehnung, Lokalisation der VM und die Effizienz des Sklerosierungsmittels sind entscheidend für den Therapierfolg.Background. Venous vascular malformations are the most common vascular anomaly. They are congenital and may present in any anatomical location. Most of them are found in the head and neck. Venous malformations typically present as soft, compressible, non-pulsatile masses with blue discoloration on clinical examination. They expend under rising venous pressure for example in the head-down position. The current methods of treatment include sclerotherapy, surgery, laser therapy or a combination of these. Aim of the work. The treatment of VVMs in the mandibular region by sclerotherapy was evaluated. The efficiency of the treatment was primarily measured by the reduction of symptoms. In addition, size reduction and reduction of signal intensity in the T2 sequence were added as further secondary criteria. The complications of the applied sclerosing agents were evaluated. Material and methods. 82 patients from the Hospital of Heinrich Heine University Düsseldorf and the Alfried Krupp Hospital Essen were retrospectively included over a period of 15 years. They were treated with five different sclerosing agents: bleomycin, ethanol, ethoxysclerol, fibrovein and picibanil. Clinical symptoms and magnetic resonance imaging were evaluated before and after sclerotherapy. Clinical treatment success was divided into 3 categories: 1) clinically symptom-free 2) improvement of symptoms 3) no change or worsening. MR imaging before and after treatment was used to measure the size and signal intensity. Results. A total of 540 sclerotherapy procedures (median 4) were performed, 166 with fibrovein, 209 with bleomycin, 94 with ethanol, 51 with ethoxysclerol and 20 with picibanil. 47 patients were subsequently symptom-free (57%), 32 with reduced symptoms (39%) and in 3 patients (4%) symptoms were unchanged. Volume reduction on MRI was >75% in 27 patients, between 50-75% in 21 patients, 25-50% in 13 patients and <25% in 21 patients. A reduction in signal hyperintensity on T2 imaging was greater than 75% in 4 patients, 50-75% in 40 patients, 50% in 23 patients, 25-50% in 12 patients and >25% in 3 patients. Complications occurred in one patient after sclerotherapy with ethanol. Conclusion. Sclerotherapy of venous malformations is well tolerated and effective. In this retrospective evaluation after 540 sclerotherapies, a positive result has been achieved in 89% of cases. The extent, localisation of the VM and the efficiency of the sclerosing agents are decisive for the success of the therapy. | |||||||
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| Bezug: | 01.01.2006-31.10.2021 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät » Institute » Institut für Diagnostische Radiologie | |||||||
| Dokument erstellt am: | 24.05.2024 | |||||||
| Dateien geändert am: | 24.05.2024 | |||||||
| Promotionsantrag am: | 13.02.2024 | |||||||
| Datum der Promotion: | 21.05.2024 |
