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DOI: 10.1055/s-0032-1315105
CT-gesteuerte Elektrodenplatzierung zur Sakralnervenstimulation bei Stuhlinkontinenz (cSNS)
CT-Guided Electrode Placement for Sacral Nerve Stimulation in the Treatment of Faecal Incontinence (cSNS)Publication History
Publication Date:
18 December 2012 (online)
Zusammenfassung
Hintergrund: Die Sakralnervenstimulation (SNS) kann in der Testphase in Lokalanästhesie durchgeführt werden. Die Implantation der Tined-Lead-Elektroden erfolgt in der Regel stationär in Vollnarkose. Ein ambulantes Vorgehen sowohl für Test- als auch Permanentimplantation bietet entscheidende Vorteile hinsichtlich der Präzision der Elektrodenplatzierung. Material und Methoden: Von 2006 bis 2011 wurden insgesamt 51 Patienten mit SNS ambulant und in Lokalanästhesie behandelt. Ergebnisse: Von 51 Patienten war bei 4 Patienten die PNE nicht erfolgreich, hier waren die Neuroforamen zu eng für eine Elektrodenimplantation oder es waren Dysästhesien aufgetreten. Bei 39 der 47 gescreenten Patienten war die Testphase positiv. Achtmal war die Testung negativ. Die funktionellen Ergebnisse zeigen einen signifikanten Rückgang des Cleveland-Scores von 14,9 auf 6,4. Der manometrische Ruhedruck verbesserte sich von 23,4 mmHg auf 43,81 mmHg, der Willkürdruck von 42,2 mmHg auf 76,12 mmHg. Nach subjektivem Empfinden und optimaler Reizantwort wurden die Elektroden 11-mal in S4 links, 23-mal in S3 links, 3-mal in S3 rechts, 1-mal in S2 links und 1-mal in S2 rechts platziert. Schlussfolgerung: Die CT-gesteuerte Elektrodenplatzierung ist für temporäre (subchronische) und permanente (chronische) Sakralnervenstimulation sicher und bietet ein wertvolles Mittel zur Platzierung des Stimulationsmaterials.
Abstract
Background: The sacral nerve stimulation (SNS) can be performed in the screening phase under local anaesthesia. Implantation of the tined-lead electrodes is usually performed in an inpatient setting under general anaesthesia. An outpatient procedure for both PNE and implantation of the electrodes offers decisive advantages with respect to the accuracy of electrode placement. Materials and Methods: From 2006 to 2011 a total of 51 patients was treated with SNS in an outpatient setting. Results: Of 51 patients having the PNE, in four patients the procedure could not successfully be completed. In 39 of the 47 patients screened, the testing was positive. Eight times the screening was negative. The functional results show a significant decline in the Cleveland scores from 14.9 to 6.4. The manometric resting pressure improved from 23.4 mmHg to 43.81 mmHg, the squeezing pressure improved from 42.2 mmHg to 76.12 mmHg. Due to patientsʼ perception and according to the response on the stimulus, the electrodes were placed on the left in S4 11 times, 23 times in the left S3, 3 times in the right S3, once in the left S2 and once in the right S2. Conclusion: CT-guided electrode placement is safe for temporary (subchronic) and permanent (chronic) sacral nerve stimulation and provides a valuable means for placement of the stimulating material.
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