Interdisziplinäre Therapie infantiler Hämangiome

Zusammenfassung

Die mittlerweile weltweit akzeptierte Eintei-lung der vaskulären Anomalien nach der International Society for the Study of Vascular Anomalies unterscheidet Hämangiome im Sinne proliferierender Neubildungen, die meist kurz nach der Geburt auftreten, und vaskuläre Malformationen als anlagebedingte Fehlbildungen, die bereits bei der Geburt vorhanden sind. Vaskuläre Malformationen werden je nach Hämodynamik und Morphologie in Low-Flow-und High-Flow-Malformationen (arteriovenöse Malformationen) mit hoher Durchflussrate unterteilt. Gemeinsames Merkmal sind der Fehlbildungscharakter der Läsionen und die nicht gegebene Möglichkeit einer Spontanre-mission.

Bei Säuglingen und Kleinkindern sind überwiegend Hämangiome von therapeutischer Relevanz. Diese infantilen Hämangiome sind vor allem in der Kopf-/Halsregion lokalisiert und zeigen nach der initialen Proliferations-phase häufig eine Spontanremission. Bei funk-tionell einschränkenden Hämangiomen um Körperöffnungen und/oder Hämangiomen mit starker Wachstumsneigung besteht jedoch häufig zuvor dringender therapeutischer Handlungsbedarf.

Die therapeutischen Optionen umfassen die systemische oder lokale Behandlung mit Beta-blockern, die Operation, verschiedene Laser-verfahren, die Kontaktkryotherapie oder die Kombination verschiedener Verfahren. Kortikosteroide bleiben mittlerweile Sonderfällen vorbehalten. Die Therapieentscheidung sollte interdisziplinär im Rahmen einer Spezialsprechstunde getroffen werden, ferner ist ein regelmäßiges Follow up mit fotografischer Befunddokumentation notwenig.

Summary

Vascular anomalies are classified according to the International Society for the Study of Vascular Anomalies in infantile haemangiomas and vascular malformations. Infantile haemangiomas (IH), the most common tumor of infancy, are characterized by an initial proliferation during infancy followed by spontaneous involution over the next 5–10 years. Vascular malformations do not show any spontaneous involution. This basic understanding is fundamental for further treatment decisions. In large or multiple hemangiomas, life-threatening hemangiomas and problematic hemangiomas with ulceration, infection, bleeding, dysfunction and/or delicate localization treatment options include systemic or topical therapy with beta blockers, surgery, laser therapy, cryotherapy or combined therapy. Corticosteroids remain confined to special situations. State of the art in the treatment of haemangiomas and vascular malformations is an interdisciplinary approach with continuous follow up.

Schlüsselwörter

Hämangiom - Betablocker - Operation - Laser - Kryotherapie

Keywords

Haemangioma - propranolol - surgery - laser - cryotherapy

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