The caudal space in fetuses: an anatomical study

Aggarwal, Anjali; Sahni, Daisy; Kaur, Harsimran; Batra, Yatindra Kumar; Sondekoppam, Rakesh V.

doi:10.1007/s00540-011-1271-8

Cited by 11 publications

(12 citation statements)

References 18 publications

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“…In contrast, our study demonstrates the nerve in the middle third between a line from the PSIS to the IT, and reports the location of the SN as more inferior (PSIS to IT distance) and slightly more medial (GT‐IT distance) in the gluteal region than described in adults. We suggest that this can be explained by differences in the morphology of the pelvis in young children (Aggarwal et al, ; Lees et al, ; Mirjalili et al, ). The position of the SN remains similar in all the age groups studied, but the nerve is located marginally closer to the IT in older children.…”

Section: Discussionmentioning

confidence: 85%

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

2015

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No anatomy text specifically describes the course of the sciatic nerve (SN) in the gluteal region in children. Anatomical information is largely derived from cadaveric studies of adults, so accurate anatomical information about the location of the SN in children is required. The aim of this study is to assess the surface anatomy of the SN in children using computed tomography (CT). After excluding studies with pelvic pathology, 75 CT scans were analyzed. Three groups were selected for analysis (0-2, 4-6, and 8-10 years). The position of the SN was measured between the posterior superior iliac spine (PSIS) and the ischial tuberosity (IT) and between the IT and the greater trochanter (GT) using 3-dimensional images. In the 0-2 age group, the SN crossed the middle third of a line between the PSIS and the IT in 94% and the GT and the IT in 80% of cases. In the 4-6 age group, the SN crossed the middle third of a line between the PSIS and the IT in 96% and the GT and the IT in 87%. In the 8-10 age group, the SN crossed the middle third of a line between the PSIS and the IT in 100% and the GT and the IT in 71%. The findings indicate that the SN in children is most accurately located in the middle third along a line drawn from the PSIS to the IT and the GT to the IT. Our study is the first to provide anatomical CT data from living children to guide interventions in the gluteal region.

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Section: Discussionmentioning

confidence: 85%

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

2015

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“…The distances to the dura ranged from 3 to 13 mm. The AP canal depth ranged from 1.7 to 4.4 mm . These findings highlight the greater risk of inadvertent dural puncture in the neonate compared with older children or adults.…”

Section: Internal Anatomymentioning

confidence: 86%

A review of the surface and internal anatomy of the caudal canal in children

Lees

Frawley

Taghavi

et al. 2014

Pediatric Anesthesia

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The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of the possible anatomical variations is critical to the safety and success of caudal epidural blocks, particularly when image guidance is not employed. This systematic review analyzes the available evidence on the clinical anatomy of the caudal canal in pediatric patients, emphasizing surface anatomy and internal anatomical variations. A literature search using three electronic databases and standard pediatric and anatomy reference texts was conducted yielding 24 primary and seven secondary English-language sources. Appreciating that our current landmark-guided approaches to the caudal canal are not well studied in the pediatric population is important for both clinicians and researchers.

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“…Aggarwal et al [5] reported in a study conducted with 39 fetal cadavers that the terminal of the dural sac was most frequently at the S2 level (58.97%), followed by the S3 level (12.82%). In addition, they reported that the apex of sacral hiatus was observed most frequently at the S3 level, indicating that the distance between the apex of the hiatus and the dura was only 3 to 13 mm.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure has been known to have a high success rate and a low risk of complications in comparison to other neuraxial block procedures which can be performed in children [1,3]. However, many studies conducted with adults and children have shown that there are many variations in important anatomical structures for the procedure [4,5,6,7]. These variations increase the difficulty of the procedure and increase the risk of complications.…”

Section: Introductionmentioning

confidence: 99%

“…Until now, anatomical investigation for caudal epidural block in children has been performed by means of fetal cadaver [5] and MRI [9]. However, both of the studies did not consider the development process of the sacral canal depending on the age of the children and only focused on the optimal needle trajectory for effective caudal epidural block.…”

Section: Introductionmentioning

confidence: 99%

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Morphologic Diversities of Sacral Canal in Children; Three-Dimensional Computed Tomographic Study

et al. 2014

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BackgroundCaudal block is a common technique in children for reducing postoperative pain, and there have been several reports on the variations of the sacral canal in children. However, previous studies have mainly focused on the needle trajectory for caudal block, and there is limited information on the structural variations of the sacrum in children. The purpose of this study was to analyze the anatomic variations of sacral canals in children.MethodsThree-dimensional computed tomographic images were analyzed. The data from the images included ① fusion of the sacral vertebral laminae and the sacral intervertebral space ② existence of the sacral cornua and ③ the types of sacral hiatus. The types of sacral hiatus were classified into 3 groups: group I (fusion of S3 or S4 vertebral laminae), group II (unfused vertebral arch with the distance of the S3 and S4 vertebral laminae < 50% of the distance between the cornua), and group III (unfused vertebral arch with the distance of the S3 or S4 vertebral laminae ≥ 50% of the distance between the cornua).ResultsA total of 143 children were included in this study. All of the sacral vertebral arches were not fused in 22 children (15.4%). Cornua were not identified bilaterally in 5 (3.5%) and unilaterally in 6 (4.2%) children. In the sacral hiatus, group II and group III were identified in 22 (15.4%) and 31 (21.7%) children, respectively.ConclusionsThe sacral canal has various anatomical variations in children. Careful attention must be paid to identify the correct anatomic landmark.

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The caudal space in fetuses: an anatomical study

Cited by 11 publications

References 18 publications

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

Revisiting the surface anatomy of the sciatic nerve in the gluteal region in children using computed tomography

A review of the surface and internal anatomy of the caudal canal in children

Morphologic Diversities of Sacral Canal in Children; Three-Dimensional Computed Tomographic Study

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