Sektionstage Frühjahr 2025 der Deutschen Gesellschaft für Neurochirurgie

Dr. med.

PD Dr. med.

Titel EN: Application of stimulated Raman histology for intraoperative tissue examination in the reconstruction of peripheral nerve injuries

Prof. Dr.

Dr. med. univ.

Einsatz Stimulierter Raman Histologie zur intraoperativen Gewebeuntersuchung bei der Rekonstruktion peripherer NervenverletzungenApplication of stimulated Raman histology for intraoperative tissue examination in the reconstruction of peripheral nerve injuries

Innovative OP- und Rehabilitationstechniken

SPN02

Freie Themen

SPN05

Für die funktionelle Erholung nach operativer Rekonstruktion einer traumatischen Nervenläsion ist eine intraoperative Beurteilung der Qualität der Nervenstümpfe entscheidend. Die neuromatös veränderten Nerven können schrittweise zurückgeschnitten und visuell sowie ggf. palpatorisch auf gesunde Faszikel untersucht werden. Histologische Schnellschnittuntersuchungen sind objektiver, aber zeitaufwendig. Mittels Stimulierter Raman Histologie (SRH) sind Binde-, Fett und Nervengewebe eindeutig und extrem schnell identifizierbar.1 Der intraoperative Einsatz von SRH zur Definition des optimalen Rückschnitts bei traumatischen Nervenläsionen bietet sich somit an.Ziel dieser experimentellen Studie ist es, eine einfache, schnelle und sichere Technik für das intraoperative Assessment von Nerven mittels SRH zu entwickeln.Aus intraoperativ gewonnenen, humanen Nervenproben wurden nach Einbettung in Low-Melting Agar mittels hochpräzisem Schneideblock 500µm dünne Schnittpräparate erzeugt.Die Schnittpräparate konnten mit dem erzeugten Arbeitsablauf ausreichend dünn hergestellt werden, dass eine Analyse mittels SRH möglich und klinisch in kurzer Zeit praktikabel war. Dabei wurde insbesondere der Anteil der longitudinal abgebildeten Nervenfasern beurteilt.Der intraoperative Einsatz von SRH im Rahmen einer Nervenrekonstruktion nach traumatischer Ruptur zur Beurteilung der Qualität der Nervenstümpfe dient der Definition des optimalen Rückschnitts und ist entscheidend für die funktionelle Erholung. Die hier entwickelte Technik soll zeiteffizient, einfach und sicher in der Handhabung sein und sich somit gut in den operativen Alltag integrieren lassen. Zukünftig könnte die Methodik auch die Entwicklung eines maschinellen Lernansatzes, z. B. zur automatischen Quantifizierung des Myelin-Gehalts, ermöglichen.

Einsatz Stimulierter Raman Histologie zur intraoperativen Gewebeuntersuchung bei der Rekonstruktion peripherer Nervenverletzungen

Sektion Periphere Nerven:

Abstractvortrag

Prof. Dr. med.

Advancing Peripheral Nerve Surgery: Innovations and Frontiers in Tissue Engineering and Therapeutic StrategiesFortschritte in der peripheren Nervenchirurgie: Innovationen und Grenzen der Gewebetechnologie und therapeutische Strategien

Peripheral nerve injuries pose significant challenges in clinical practice due to limited regenerative capacity and suboptimal outcomes with current treatment options. This abstract highlights the latest advancements in tissue-engineered materials and therapeutic strategies aimed at enhancing nerve regeneration and functional recovery, providing insights into their clinical potential and existing limitations.A comprehensive analysis of the latest in vivo studies on natural, synthetic, and composite nerve guide conduits (NGCs), hydrogels, microspheres, and cell-based therapies was conducted. Emphasis was placed on their structural, biochemical, and electrical properties, as well as their integration with growth factors and cells to enhance axonal growth, myelination, and vascularization.Natural materials, such as collagen-based NGCs, provide biocompatibility but often fall short in mechanical robustness and scalability. Synthetic conduits incorporating nanofibers and bioactive polymers exhibit improved structural support and conductivity, promoting axonal growth. Composite materials offer tailored degradation profiles and improved cellular support but remain inferior to autografts in clinical efficacy. Hydrogels and microspheres enable controlled delivery of neurotrophic factors like glial cell-derived neurotrophic factor (GDNF) and brain-derived neurotrophic factor (BDNF), enhancing localized regeneration. Cell-based approaches using Schwann cells and stem cells embedded in engineered scaffolds show promise in augmenting myelination and angiogenesis. Innovations such as electrically conductive or piezoelectric scaffolds further mimic natural nerve tissue properties, enhancing regeneration under electrical stimulation.Despite advancements, autologous grafting remains the gold standard for PNI repair. Tissue-engineered materials and cell-based approaches hold significant potential but require further refinement to match the clinical outcomes of autografts. Future research should focus on enhancing scalability, biocompatibility, and functional integration of these technologies to bridge the gap between preclinical promise and clinical application.

Fortschritte in der peripheren Nervenchirurgie: Innovationen und Grenzen der Gewebetechnologie und therapeutische Strategien

Titel EN: Unraveling the Mystery of Neuroma: Insights into Tissue Characteristics and Regenerative Pathways

Dr rer nat

Unraveling the Mystery of Neuroma: Insights into Tissue Characteristics and Regenerative PathwaysEntschlüsselung des Neuroms: Einblicke in Gewebecharakteristika und regenerative Wege

Peripheral nerve injuries follow a distinct timeline, transitioning from acute degeneration to attempted regeneration. In humans, this process often culminates in neuroma formation, a fibrotic scar that hinders recovery. This study aims to characterize the injury response, highlighting the divergence between healthy nerve regeneration and human neuroma formations. A particular focus is placed on cellular and molecular mechanisms driving neuroma development, including dysregulated signaling pathways, angiogenesis, and Schwann cell behavior.Histological and cellular studies examined Schwann cell activity, angiogenesis, and extracellular matrix remodeling to reveal their roles in neuroma formation and regeneration. RNA sequencing (RNA-Seq) was employed to compare healthy nerve and neuroma tissues and cultured Schwann cells from both tissues. Differentially expressed genes (DEGs) and disrupted signaling pathways were identified.Histological analyses revealed that neuromas are characterized by sustained inflammation, excessive collagen deposition, and disorganized axonal regrowth linked to dysregulated angiogenesis. Schwann cells in neuromas displayed increased proliferation, contributing to unstructured axonal outgrowth and fibrotic scarring. RNA-Seq analyses identified altered DEGs between neuroma and healthy nerve tissues, highlighting pathways involved in axon guidance, extracellular matrix regulation, angiogenesis, and brain-derived neurotrophic factor (BDNF) signaling.Neuroma formation represents a maladaptive response to peripheral nerve injury, driven by disrupted molecular signaling and cellular behaviors. Insights from histological and molecular studies emphasize the need for targeted therapeutic approaches to regulate angiogenesis, support Schwann cell function, and minimize fibrotic scarring. These findings lay the groundwork for developing interventions to enhance nerve regeneration and improve clinical outcomes for patients with peripheral nerve injuries

Entschlüsselung des Neuroms: Einblicke in Gewebecharakteristika und regenerative Wege

Prof.

PD Dr.

Imaging in Peripheral Nerve Tumors: Diagnostic Approaches and Challenges, Data from the Peripheral Nerve Tumor Registry

Schmerzen bei Tumoren peripherer Nerven

SPN04

Imaging is vital for detecting and characterizing peripheral nerve tumors (PNTs). Magnetic resonance imaging (MRI) is the gold standard due to its superior soft tissue resolution. Additional modalities, like computer tomography (CT), ultrasound, and PET-CT, complement MRI findings. However, the heterogeneous nature, variable sizes, and diverse anatomical locations of PNTs pose significant challenges for accurate imaging and diagnosis.This sub-study of the Peripheral Nerve Tumor Registry (PNTR) analyzed preoperative imaging data from 390 patients across five centers in Germany and Austria. The analysis focused on tumor size, contrast enhancement, T2 signal characteristics, and tissue infiltration patterns. MRI was evaluated explicitly for its ability to provide detailed information on tumor morphology, perilesional infiltration, and edema.Tumors were histologically classified into benign (Group 1, 81%), malignant (Group 2, 6%), and rare (Group 3, 13%) groups, with mean sizes of 33 mm, 100 mm, and 60 mm, respectively showing that tumors in the benign group were significantly smaller compared to malignant and rare tumors (p<0.001). MRI was the primary imaging modality (n=375), but significant variability in protocols and incomplete sequences (e.g., 7% without contrast, 22% without T2, 95% without ADC) were noted. In 94% of cases, contrast enhancement was observed, with heterogeneous patterns predominating in malignant and rare tumors. Inhomogeneous T2 signals were common (211 cases), often accompanied by cysts (96 cases), and more frequent in malignant (79%) and rare (43%) tumors. Tissue infiltration (n=27) and perilesional edema (n=12) were mainly associated with malignant and rare tumors (93%). FDG-PET showed overlapping metabolic activity between benign and malignant tumors, with SUVmax values ranging from 6.1 to 33.7.MRI distinguishes tumor subtypes and aids surgical planning but cannot preoperatively predict all entities accurately. Standardized MRI protocols are essential for improving diagnostic precision, patient outcomes, and surgical planning.

kleiner Hörsaal

PN 4

Technik und Innovationen

Sektion Periphere Nerven

PN 4
Technik und Innovationen

Appointment

Chairs

Programme

PN 4Technik und Innovationen

Appointment

Chairs

Programme

PN 4
Technik und Innovationen