Perineal pain and inferior cluneal nerves: anatomy and surgery

Abstract

Neuropathic perineal pains are generally linked to suffering of the pudendal nerve. But some patients present pains described as a type of burning sensation located more laterally on the anal margin and on areas including the scrotum or the labiae majorae, the caudal and medial parts of the buttock and the upper part of the thigh. These pains extend beyond the territory of the pudendal nerve. It is interesting to note that the inferior cluneal nerves are responsible for the cutaneous sensitivity in the inferior part of the buttock. We wanted to check if these nerves, or some of their branches, could be responsible for such pains. An anatomic study, containing six dissections on corpse, has been conducted. The inferior cluneal nerves, emerging from the posterior femoral cutaneous nerve have some branches joining the perineum, especially by a perineal ramus. However, two conflict areas have been identified on the path of these nerves and on the perineal ramus: one at the level of the sacrotuberal ligament, and the other being the passage under the ischium. Two surgical approaches have been established from these observations with the aim of suppressing the conflicts.

A new endoscopic minimal invasive approach for pudendal nerve and inferior cluneal nerve neurolysis: An anatomical study

“…The perineal branch generally arises from the medial border of the posterior femoral cutaneous nerve, on the lateral aspect of the ischiatic tuberosity and then courses subcutaneously over the origins of the hamstring muscles in the ischial tunnel. The perineal branch innervates the lateral anal, scrotal or labial skin . A fibrous arcade has been described as a potential site of entrapment of these branches.…”

Novel approaches in the treatment of systemic mastocytosis

“…Several burning pain conditions affecting the perineal region may involve HE TRPV1 afferents. Neuropathic perineal burning pain occurs with compression of pudendal or cluneal nerves (Darnis et al,2008). In vulvodynia of the vestibulitis type, pain, hyperalgesia, and allodynia are localized to the vulval vestibule, which exhibits increased innervation particularly of TRPV1 afferents (Tympanidis et al,2004).…”

3-Tesla High-Field Magnetic Resonance Neurography for Guiding Nerve Blocks and Its Role in Pain Management

“…A positive pain response will identify the posterior femoral cutaneous nerve as an additional contributor to the pain syndrome, whereas the negative pain response (true negative response) will further validate the positive pain response of the pudendal nerve block. 51,52 A valid posterior femoral cutaneous nerve block requires perineural drug delivery and absence of spread to the pudendal nerve. With high-spatialresolution MR neurography (Fig.…”