Fascicular anatomy and surgical access of the human pudendal nerve

Abstract

The ability to access selectively distal nerve branches at the level of the compound pudendal nerve (PN) would allow control of multiple neural pathways and genitourinary functions at a single location. Nerve cuff electrodes can selectively stimulate individual fascicles; however the PN fascicular anatomy is unknown. The fascicular representation of distal branches was identified and traced proximally to create fascicle maps of 12 compound PNs in seven cadavers. Distal nerves were represented as groups of individual fascicles in the PN. Fascicle maps were consistent between specimens and along the PN within specimens. PN branch free length was 26+/-7.7 mm. PN cross-sections were relatively flat with major and minor diameters of 4.3+/-0.90 and 1.7+/-0.45 mm, respectively. Placing a nerve cuff on the PN is anatomically and surgically feasible. The PN fascicular anatomy, branch free length, and cross-section geometry are conducive to selective stimulation of distal nerves with a single nerve cuff electrode.

The Feline Dorsal Nerve of the Penis Arises from the Deep Perineal Nerve and Not the Sensory Afferent Branch

“…The human DNP arises from the PN usually distal to the EAS branch but separately from the perineal nerve (Juenemann et al, 1988;Shafik et al, 1995;Schraffordt et al, 2004;Gustafson et al, 2005). This is largely analogous to the described feline neuroanatomy, in which the DNP arises distal to the EAS and AFF branches but is itself a distal continuation of the DPN as opposed to a separate terminal branch of the PN.…”

Human distal sciatic nerve fascicular anatomy: Implications for ankle control using nerve-cuff electrodes

“…McKinley did not identify subgroups proximal to the sciatic bifurcation [17], and Sunderland and Ray were unable to distinctly trace unique fascicles above the joint space because of interfascicular plexusing [18]. Although early studies reported difficulties tracing fascicular anatomy along nerves [18], more recent work [28] and work from our laboratory [22,29] has demonstrated that fascicular tracing is consistent in a number of peripheral nerves.…”

Quelle est la place de l’examen électroneuromyographique dans le diagnostic des névralgies pudendales liées à un syndrome canalaire?

“…En revanche, des douleurs à projection exclusivement postérieure peuvent être liées à une atteinte isolée du nerf rectal inférieur lors de son émergence du canal d'Alcock. Deuxièmement, une atteinte fasciculaire intraneurale peut expliquer une symptomatologie limitée à une subdivision du territoire tronculaire pudendal [15], par analogie aux atteintes dissociées du tronc sciatique n'affectant que les fibres à destinée fibulaire [16]. Troisièmement, un conflit situé au niveau de l'épine sciatique va entraîner une perte de mobilité du nerf en aval et l'exposer à un conflit en position assise dans le canal d'Alcock par écrasement sur le prolongement falciforme du ligament sacrotubéreux sans qu'il y ait pour autant une compression chronique associée à ce niveau.…”