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PubMed1988

Dorsal root entry zone lesions in the treatment of pain following brachial plexus avulsion, spinal cord injury and herpes zoster.

This paper details the long-term results in patients treated with dorsal root entry zone (DREZ) lesions for the treatment of pain following brachial plexus avulsion, spinal cord injury, and herpes zoster. With our current operative technique, 82% of patients with brachial plexus avulsion injuries were afforded long-term pain relief. Patients with pain confined to dermatomes just below the level of spinal injury also did well with DREZ lesions, although the results were less good in patients with diffuse pain or with sacral pain. The postoperative results in patients with postherpetic pain were disappointing.

Adult↗
PubMed1975

[Studies on the pudendal nerve. Part 4. A macroscopical observation of the branches of the pudendal plexus in dogs and cats (author's transl)].

The pudendal plexus and its branches of 20 dogs and 20 cats have been observed macroscopicaly. The main findings are summarized as follows: 1) The pudendal plexus in dogs is formed most frequently by the ventral rami of the first, second and third sacral nerves. 2) The bigeminal nerve of dogs and cats is formed respectively by the union of the ventral rami mentioned above. 3) The perineal nerve in dogs arises with one root from the bigeminal nerve and that of cats two roots, of which the main root arises from the points where the bigeminal nerve joins the asciatic nerve and the accessory one from the bigeminal nerve. 4) In dogs and cats the dorsal nerve of the penis or clitoris arises from the main trunk of the perineal nerve (Fig. 5, type IB) at an average rate of 57.5%. 5) In the dogs and cats, the inferior rectal nerve consists of two divisions; a division had the branches which are derived the perineal nerve to supply the skin around the anus and the other branches which arises from the muscular branch of the dorsal nerve of the penis or clitoris to supply the Sphincter ani externus. 6) The muscular branch of dogs and cats which is analogous to that of the perineal nerve in man, arises from the dorsal nerve of the penis or clitoris. 7) In dogs and cats the muscular branch to the Obturator internus is derived from the dorsal nerve of penis or clitoris. 8) The pelvic splanchnic nerve of dogs originates from the ventral rami of the first, second and third sacral nerves and that of cats from the ventral rami of the first and second sacral nerves. 9) In the posterior femoral cutaneous nerve in dogs, as well as in rats and rabbits, the lateral deviation of the origin from the sciatic to the perineal nerve is observed.

Animals↗
PubMed1997

Continence mechanism of the isolated female urethra: an anatomical study of the intrapelvic somatic nerves.

PURPOSE: A neuroanatomical study was initiated to gain better insight into the continence mechanism of the isolated urethra in women. MATERIALS AND METHODS: We performed a detailed gross and histological neuroanatomical study to identify the intrapelvic somatic pathway from the sacral spinal cord to the female urethral sphincter. Gross anatomical dissection was performed in 5 formalin fixed female adult pelvises by tracing the autonomic nerves from the pelvic plexus and the spinal somatic nerves from S2-S4 to the urethral sphincter. Immunohistochemical staining of urethral step sections with a neuropeptide specific antibody was performed to demonstrate the course of the periurethral somatic nerves in relation to the vaginal wall. RESULTS: Our study demonstrated an intrapelvic somatic pathway derived from the S2, S3 and S4 sacral roots, distinct from the peripheral pudendal nerve, supplying the levator ani and the urethra. The somatic nerves travel beneath the endopelvic fascia in close relation to the inferior vascular pedicle of the bladder and are susceptible to injury during radical pelvic surgery. Mixed autonomic fibers from the pelvic plexus travel along the course of the ureter and are also intimately associated with the vascular pedicle of the bladder. Immunohistochemical staining of urethral step sections demonstrated that the periurethral nerves travel in close relation to the lateral and anterior vaginal wall. CONCLUSIONS: We believe that the identification of intrapelvic somatic pathways to the urethra provides a basis for developing surgical techniques to preserve urethral somatic innervation during radical pelvic surgery in women.

Adult↗
PubMed1996

Surface localization of sacral foramina for neuromodulation of bladder function. An anatomical study.

A method is described for percutaneous localization of the sacral foramina, for neuromodulation of bladder function. We carried out an anatomical study of 5 male and 5 female human cadaver pelves. Using the described surface markings, needles were placed percutaneously into all sacral foramina from nine different angles. Paths of needle entry were studied by subsequent dissection. We observed that although it was possible to enter any sacral foramen at a wide range of insertion angles, the incidence of nerve root/vascular penetration increased with increasing angle of needle entry. Also, the incidence of nerve root penetration was higher with the medial approach compared with lateral entry. The insertion of a needle into the S1 foramen was associated with a higher incidence of nerve root penetration and presents a potential for arterial haemorrhage. On the other hand the smaller S3 and S4 nerve roots were surrounded by venous plexuses, presenting a potential source of venous haemorrhage during procedures. Our study suggests a new method for identifying the surface markings of sacral foramina and it describes the paths of inserted needles into the respective foramina. In addition, it has highlighted some potential risk factors secondary to needle insertion.

Electric Stimulation↗
PubMed1992

Cranial and sacral dural arteriovenous fistulas as a cause of myelopathy.

The authors report a series of seven patients with myelopathy who were found to have spinal dural arteriovenous (AV) fistulas in which the nidus was located at some distance from the spinal cord. The nidus was intracranial in three cases and involved a sacral nerve root sheath in the other four; in each case, the arterialized draining vein led into the coronal plexus of medullary veins. A lack of normal draining radicular veins was noted in all cases. Magnetic resonance images were obtained in four patients and demonstrated spinal cord tissue changes only in the lower thoracic cord in three cases and in the cervical cord in one, all consistent with an ischemic process secondary to venous hypertension. Five patients were managed surgically by division of the draining vein, with improvement of the neurological deficit in all. One patient was treated by embolization alone and had stabilization of her deficit. The remaining patient in the series died of unrelated systemic disease before the spinal dural AV fistula could be treated. These cases support the theory that venous hypertension is the dominant pathophysiological mechanism involved in spinal dural AV fistulas independent of their location. In patients with a suspected spinal dural AV fistula, lumbar and thoracic spinal angiography will reveal the site of the fistula in the majority of cases (88% in this series). In the remaining patients, the possibility of a remote fistula must be considered. The lack of normal venous drainage of the cord following injection in the artery of Adamkiewicz is the most reliable indicator of venous hypertension in the cord and can be helpful in making the decision to proceed with a search for a cranial or sacral arterial supply.

Adult↗
PubMed1999

Caverno-pudendal nervous communicating branches in the penile hilum.

Classically, the peripheral neural pathways for erection are proerectile, issuing from the parasympathetic sacral fibres, and antierectile from the thoracolumbar sympathetic trunk. The cavernous nerves as terminal branches of the pelvic plexus convey the parasympathetic fibres to the penis. The pudendal nerve conveys sensory fibres from the penis and somatic fibres to the bulbos-pongiosus and ischiocavernosus striated mm. In animals, it has been demonstrated that the dorsal nerve of the penis contains sympathetic fibres. These findings suggest that communicating branches exist between the cavernous nerves and the dorsal nerve. Our aim in this study was to demonstrate the presence of such connections in man. We dissected 20 fresh male cadavers. The pelvic plexus and pudendal nerves were dissected to identify their terminal branches and connections. Histologic study was performed. Our results showed evidence of communicating nervous branches between the cavernous nerves and the dorsal nerve of the penis. Several variants existed concerning the number and type of connections. The presence of such communicating branches proves that the supralevator and infralevator neural pathways communicate and suggest the possibility of a kind of plasticity of the nervous supply of penile erection. Further studies are needed to identify the nature of these communicating branches.

Adult↗
PubMed2006

Urinary retention following tension-free vaginal tape successfully treated by sacral neuromodulation.

Postoperative urinary retention following anti-incontinence surgery has traditionally been thought to be due to overcorrection. There is increasing evidence, however, that a neurogenic component may also play a significant role. This is a case report of a 72-year-old woman who developed delayed partial urinary retention following a tension-free vaginal tape which resolved with initial sacral neuromodulation.

Aged↗
PubMed1978

Intramedullary syndrome due to an extradural neurinoma near the foramen magnum.

A case of right sided extradural neurinoma at the level of the foramen magnum is reported which presented as an intramedullary spinal cord syndrome. Ischemia of the anterior spinal artery or of the vertebral artery was considered to be an important pathogenic factor in the production of the neurological syndrome. The outer part of the spinothalamic tract, where sensory fibers carrying pain and thermal sensibility from the sacral segments are situated, escaped ischemia as that part is supplied by penetrating branches of the pial arterial plexus. The discrepancy between the level of neurological deficit (C5) and site of the tumor (C1-2) was due to distant ischemia. The lack of a history of root pain and the rapid recovery following removal of the tumor also favor a vascular origin for the neurological deficit.

Humans↗
PubMed1993

Superiority of the fasciocutaneous flap in reconstruction of sacral pressure sores.

The gluteal maximus muscle has been used in the treatment of sacral pressure sores since the 1970s. However, it is noted that the muscle portion of the transferred flap shows highly atrophic degeneration and the muscle itself is not suitable tissue for covering the pressure-bearing area. We have managed various fasciocutaneous flaps as the first choice for reconstruction of sacral pressure sores and obtained good results. The fasciocutaneous flap has an anatomical structure that resists physical stimulation or external pressure and an abundant blood supply via its fascial plexus. In addition, if we use a gluteal maximus myocutaneous flap at first, some fasciocutaneous flaps are compromised because of the design and blood supply. We suggest that the fasciocutaneous flap has the first priority and is superior to the gluteal maximus myocutaneous and muscle flaps in reconstruction of sacral pressure sores.

Adult↗
PubMed1978

[Development and topography of the ganglion pelvinum in the gerbil].

In the gerbil the nerve cells of the plexus pelvinus are concentrated on each side in a solid glanglion pelvinum. This deviates essentially from the pattern in man and the domestic animals where these cells are scattered all over the plexus pelvinus. The large ganglion pelvinum is connected craniodorsally with the nervus hypogastricus and dorsally with the nervi pelvini (from the first 2 or 3 sacral nerves and the last lumbar nerve). The apertura pelvis cranialis appears long and very oblique and, therefore, in the gerbil the ganglion pelvinum is located on each side cranially to the corpus ossis pubis and can be reached by a ventral laparotomy.

Animals↗
PubMed1993

Urinary bladder innervation in male rat: termination of primary afferents in the spinal cord as determined by transganglionic transport of WGA-HRP.

The distribution of afferents innervating the urinary bladder in the spinal cord of male rats has been studied with the axonal tracer horseradish peroxidase conjugated to wheat germ agglutinin (WGA-HRP) injected into various portions of one side of the urinary bladder (dome, body, base, or neck) and other pelvic organs (prostate and rectum). Labeled neurons were found in dorsal root ganglia of the lumbosacral cord (L1-S3, peak in S1-S2). The strongest and most extensive transganglionic labeling of primary afferents resulted after injections in the body of the bladder. Primary afferents were observed bilaterally in Lissauer's tract and laminae I-II at the apex of the dorsal horn, from L6 to S3. The projection extended laterally up to the sacral parasympathetic nucleus and medially up to the gray matter dorsal to the central canal, where they formed a plexus of fibers and terminals. Deposits in the dome and base of the bladder labeled more heavily the medial projection, while the least intense projection was seen after injections in the bladder neck. Our results indicate a common pattern of termination of primary afferents from the bladder, although some topographical differences exist.

Afferent Pathways↗