Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse

Sağsöz, Nevin; Ersoy, M. Özcan; Kamacı, Mansur; Tekdemi̇r, İbrahi̇m

doi:10.1016/s0301-2115(01)00507-3

Cited by 40 publications

(18 citation statements)

References 9 publications

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“…However, taking into consideration the variations and SDs observed in our study and the length of SSL, a nerve-free zone only existed on the medial third of the SSL close to the sacrum. This is consistent with the findings of Sagsoz et al [27] who suggested that the medial and inferior portion of the SSL close to the sacrum is a safe site for placement of SSL fixation sutures.…”

Section: Discussionsupporting

confidence: 93%

Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study

et al. 2007

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Our objective was to document variations in the topography of pelvic floor nerves (PFN) and describe a nerve-free zone adjacent to the sacrospinous ligament (SSL). Pelvic floor dissections were performed on 15 female cadavers. The course of the PFN was described in relation to the ischial spine (IS) and the SSL. The pudendal nerve (PN) passed medial to the IS and posterior to the SSL at a mean distance of 0.6 cm (SD = +/-0.4) in 80% of cadavers. In 40% of cadavers, an inferior rectal nerve (IRN) variant pierced the SSL at a distance of 1.9 cm (SD = +/-0.7) medial to the IS. The levator ani nerve (LAN), coursed over the superior surface of the SSL-coccygeus muscle complex at a mean distance of 2.5 cm (SD = +/-0.7) medial to the IS. Anatomic variations were found which challenge the classic description of PFN. A nerve-free zone is situated in the medial third of the SSL.

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Section: Discussionsupporting

confidence: 93%

Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study

et al. 2007

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“…If surgical decompression is carried out to treat inferior rectal nerve syndrome, decompression should be directed at the point of penetration of the sacrospinous ligament to ensure optimal relief of symptoms. Our findings confirm the recommendations of Sagsoz et al (2002) for suture placement for suspension of the vaginal vault post-hysterectomy. He suggested that the medial and inferior portion of the sacrospinous ligament, close to the sacrum, is a safe site for suture placement because it is certainly quite remote from the pudendal nerve group.…”

Section: Discussionsupporting

confidence: 86%

“…Detailed knowledge of pudendal nerve variation and position adjacent to the sacrospinous ligament is relevant in multiple clinical scenarios. In sacrospinous colpopexy, a surgical procedure that corrects vaginal vault prolapse post-hysterectomy by suspending the vault to the sacrospinous ligament, understanding the course of the pudendal nerve is critical to avoid nerve injury (Sagsoz, 2002). The path of the pudendal nerve is also important in pudendal nerve blocks that necessitate penetration of the area with a needle (Roberts and Taylor, 1973;Thoumas et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament

Surin²,

2005

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The pudendal nerve (S3-S5) is a major branch of the sacral plexus. After branching from the sacral plexus, the pudendal nerve travels through three main regions: the gluteal region, the pudendal canal, and the perineum. In the gluteal region, the pudendal nerve lies posterior to the sacrospinous ligament. The relationship of the pudendal nerve to the sacrospinous ligament has important clinical ramifications, but there is a lack of literature examining the variations in pudendal nerve anatomy in the gluteal region. This study investigates the pudendal nerve trunking in relation to the sacrospinous ligament in 37 cadavers (73 sides of pelves) of 21 males and 16 females, ranging from 18-83 years of age. Pudendal nerve trunking could be grouped into five types: Type I is defined as one-trunked (41/73; 56.2%), Type II is two-trunked (8/73; 11%), Type III is two-trunked with one trunk as an inferior rectal nerve piercing through the sacrospinous ligament (8/73; 11%), Type IV is two-trunked with one as an inferior rectal nerve not piercing through the sacrospinous ligament (7/73; 9.5%), and Type V is three-trunked (9/73; 12.3%). In summary, 56.2% of pudendal nerves adjacent to the sacrospinous ligament were one-trunked, 31.5% were two-trunked and 12.3% were three-trunked. Fifteen inferior rectal nerves originated independently from the S4 root and never joined the main pudendal nerve. Eight of fifteen inferior rectal nerves pierced through the sacrospinous ligament, perhaps making it prone for entrapment. We measured the average diameter of the main trunk of the pudendal nerve to be 4.67 +/- 1.17 mm. We also measured the average length of the pudendal nerve trunks before terminal branching to be 25.14 +/- 10.29 mm. There was no significant statistical difference in the average length, average diameter, number of trunks, and pudendal nerve variations between male and female or right or left sides of the pelves. A detailed study of pudendal nerve trunking in relationship to the sacrospinous ligament would be useful for instruction in basic anatomy courses and in relevant clinical settings as well.

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“…La spinofixation peut traumatiser directement le nerf [32][33][34] ou indirectement par le biais d'un écrasement éventuel par un écarteur ou par celui d'un hématome source de fibrose compressive ultérieure, justifiant la réalisation d'une IRM postopératoire.…”

Section: La Spinoficxationunclassified

Les douleurs neuropathiques somatiques pelvi-périnéales

et al. 2006

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Le diagnostic de douleurs pelvi-périnéales en rapport avec une atteinte des nerfs somatiques est avant tout clinique. La topographie de la douleur, ses caractéristiques (brûlures, paresthésies) permettront de la rattacher au territoire neurologique impliqué. Les examens complémentaires sont relativement peu contributifs. Deux grands systèmes prennent en charge cette région : les racines sacrées d'où naissent le nerf pudendal et le nerf cutané postérieur de la cuisse ; les racines thoraco-lombaires d'où naissent les nerfs ilio-inguinal, ilio-hypogastrique, génito-fémoral et obturateur. Le premier système est avant tout périnéal, le deuxième avant tout inguino-périnéal antérieur.La névralgie pudendale est la douleur la plus fréquente et la plus invalidante, elle est évoquée devant une douleur uni-ou bilatérale du périnée antérieur ou postérieur, à type de brûlure, aggravée en position assise, soulagée debout et sans douleur nocturne. Elle est en rapport avec un mécanisme de compression nerveuse d'origine ligamentaire. Elle relève de traitements médicaux, par infiltration ou d'une libération chirurgicale. La névralgie clunéale inférieure est une douleur plutôt ischiatique et latéro-périnéale, elle s'accompagne parfois d'une atteinte dans un territoire sciatique tronqué, ces projections correspondent au nerf cutané postérieur de la cuisse, l'atteinte peut être en rapport avec un syndrome du muscle piriforme ou avec une pathologie ischiatique. Les atteintes des racines sacrées ne prennent pas un caractère aigu, elles s'accompagnent d'hypoesthésie sacrée et de troubles urinaires, anorectaux ou sexuels.Les douleurs des nerfs ilio-inguinaux, ilio-hypogastriques et génito-fémoraux sont en général le fait de traumatismes chirurgicaux avec des cicatrices pariétales. Si elles sont parfois difficiles à différencier les unes des autres, l'important est de penser à réaliser un bloc anesthésique local sur le point gâchette retrouvé au niveau de la cicatrice. Les douleurs projetées d'origine rachidienne par dérangement intervertébral mineur thoraco-lombaires se projettent au niveau inguinal, du pubis, de la grande lèvre et parfois du trochanter, elles ne s'expriment que par leurs projections douloureuses et ce n'est que l'examen clinique de principe, centré sur la région thoraco-lombaire qui trouvera des signes locaux (douleurs étagées des articulaires postérieures, cellulalgie).Mots clés : Douleur -Névralgie -Douleur pelviennePérinée -Douleur périnéale -Plexus sacré -Syndrome de compression nerveuse -Syndrome canalaire du nerf pudendal -Syndrome du canal d'Alcock -Nerf pudendal -Nerf ilio-inguinal -Nerf ilio-hypogastrique -Nerf génito-fémoral -Nerf obturateur -Charnière thoraco-lombaire Somatic neuropathic pelvi-perineal pain Abstract: The diagnosis of pelvi-perineal pain linked with a lesion of somatic nerves is mostly clinical. Topography of the pain and its characteristics (burns, paresthesia...) will allow to identify the neurological territory involved. Complementary examinations are hardly informative. Two neurological sys...

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Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse

Cited by 40 publications

References 9 publications

Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study

Anatomic variations of the pelvic floor nerves adjacent to the sacrospinous ligament: a female cadaver study

Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament

Les douleurs neuropathiques somatiques pelvi-périnéales

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