The Experts below are selected from a list of 492 Experts worldwide ranked by ideXlab platform
Rehman Irving - One of the best experts on this subject based on the ideXlab platform.
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Illustration of bones of right hemipelvis, sacrum and coccyx, posterior view
Norris Medical Library; University of Southern California. Norris Medical Library, 2011Co-Authors: Rehman IrvingAbstract:Includes labels: Superior articular process, Median sacral crst, Post. sacral foramina, Sacrum, Sacral hiatus, Coccyx, Post. superior iliac Spine, Iliac crest, Iliac fossa, Post. inferior iliac Spine, Greater sciatic notch, Ischial Spine, Lesser sciatic notc
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Natural color photograph of dissection of the left hip and buttock, posterior view, showing the sacral plexus and sciatic nerve
Norris Medical Library; University of Southern California. Norris Medical Library, 2011Co-Authors: Rehman IrvingAbstract:Includes labels: Gluteus minimus m., Obturator internus tendon, Hip capsule, Sup. gluteal vessels, Sacral plexus, Ischial Spine, Sacrospinous ligament, Obturator internus m
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Illustration of left hip joint, anterior view, showing bones and ligament
Norris Medical Library; University of Southern California. Norris Medical Library, 2010Co-Authors: Rehman Irving, Barker HelenAbstract:Includes labels: Pubic tubercle, Obturator foramen, Body of pubis, Ischial Spine, Ischial tuberosity, Lesser trochanter, Femur, Greater sciatic notch, Ant. superior iliac Spine, Ant. inferior iliac Spine, Acetabular ligament, Femoral head, Greater trochanter, Femoral nec
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Illustration of left hip joint, anterior view, showing bones and ligament
Norris Medical Library; University of Southern California. Norris Medical Library, 2010Co-Authors: Rehman Irving, Barker HelenAbstract:Includes labels: Greater sciatic notch, Ischial Spine, Lesser sciatic notch, Ischiofemoral ligament, Ilium, Ant. superior iliac Spine, Ant. inferior iliac Spine, Iliofemoral ligament, Greater trochanter, Femoral nec
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Illustration of dissection of the right hip and sacrum, posterior view, indicating the overlying structures
Norris Medical Library; University of Southern California. Norris Medical Library, 2010Co-Authors: Rehman Irving, Barker HelenAbstract:Includes labels: Sacrum, Greater sciatic notch, Ischial Spine, Lesser sciatic notch, Gluteus maximus m., Ischial tuberosity, Iliac crest, Gluteus medius aponeurosis, Ant. superior iliac Spine, Ant. inferior iliac Spine, Iliotibial trac
Stephane Ploteau - One of the best experts on this subject based on the ideXlab platform.
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a new endoscopic minimal invasive approach for pudendal nerve and inferior cluneal nerve neurolysis an anatomical study
Neurourology and Urodynamics, 2018Co-Authors: Stephane Ploteau, R Robert, Luc Bruyninx, Jerome Rigaud, Katleen JottardAbstract:AIM To describe a new minimal invasive approach of the gluteal region which will permit to perform neurolysis of the pudendal and cluneal nerves in case of perineal neuralgia due to an entrapment of these nerve trunks. METHOD Ten transgluteal approaches were performed on five cadavers. Relevant anatomic structures were dissected and further described. Neurolysis of the pudendal nerve or cluneal nerves were performed. Landmarks for secure intraoperative navigation were indicated. RESULTS The first operative trocar for the camera was inserted with regards to the iliac crest in the deep gluteal space. With the aid of pneumodissection, the infragluteal plane was dissected. The piriformis muscle was identified as well as the sciatic and the posterior femoral cutaneous nerve. Consequently, the sciatic tuberosity was visualized together with the cluneal nerves. Hereafter, the second trocar was introduced caudal to the first one and placed on an horizontal line passing at the level of the coccyx, allowing access to the Ischial Spine and the visualization of the pudendal nerve and vessels. A third 5 mm trocar was then inserted medial from the first one, permitting to dissect and transsect the sacrospinous ligament. The pudendal nerve was subsequently transposed and followed on its course in the pudendal channel. CONCLUSIONS A reliable exploration of the gluteal region including identification of the sciatic, pudendal, and posterior femoral cutaneous nerves is feasible using a minimal invasive transgluteal procedure. Consequently, the transposition of the pudendal nerve and the liberation of the cluneal nerves can be performed.
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Anatomical Variants of the Pudendal Nerve Observed during a Transgluteal Surgical Approach in a Population of Patients with Pudendal Neuralgia.
Pain Physician, 2017Co-Authors: Stephane Ploteau, Marie-aimée Perrouin-verbe, Jean-jacques Labat, Thibault Riant, Amélie Levesque, Roger RobertAbstract:BACKGROUND: Several studies have described the course and anatomical relations of the pudendal nerve. Several surgical nerve decompression techniques have been described, but only the transgluteal approach has been validated by a prospective randomized clinical trial. The purpose of this study was to describe the course of the nerve and its variants in a population of patients with pudendal neuralgia in order to guide the surgeon in the choice of surgical approach for pudendal nerve decompression. OBJECTIVES: In order to support the choice of the transgluteal approach, used in our institution, we studied the exact topography, anatomical relations, and zones of entrapment of the pudendal nerve in a cohort of operated patients. STUDY DESIGN: Observational study. SETTING: University hospital. METHODS: One hundred patients underwent unilateral or bilateral nerve decompression performed by a single operator via a transgluteal approach. All patients satisfied the Nantes criteria for pudendal neuralgia. The operator meticulously recorded zones of entrapment, anatomical variants of the course of the nerve, and the appearance of the nerve in the operative report. RESULTS: One hundred patients and 145 nerves were operated consecutively. Compression of at least one segment of the pudendal nerve (infrapiriform foramen, Ischial Spine, and Alcock's canal) was observed in 95 patients. The zone of entrapment was situated at the Ischial Spine between the sacrospinous ligament (or Ischial Spine) and the sacrotuberous ligament in 74% of patients.Anatomical variants were observed in 13 patients and 15 nerves. Seven patients presented an abnormal transligamentous course of the nerve (sacrotuberous or sacrospinous). A perineal branch of the fourth sacral nerve to the external anal sphincter was identified in 7 patients. In this population of patients with pudendal neuralgia, the pudendal nerve was stenotic in 27% of cases, associated with an extensive venous plexus that could make surgery more difficult in 25% of cases, and the nerve had an inflammatory appearance in 24% of cases. LIMITATIONS: We obviously cannot be sure that the anatomical variants identified in this study can be extrapolated to the general population, as our study population was composed of patients experiencing perineal pain due to pudendal nerve entrapment and their pain could possibly be related to these anatomical variants, especially a transligamentous course of the pudendal nerve. The absence of other prospective randomized clinical trials evaluating other surgical approaches also prevents comparison of these results with those of other surgical approaches. CONCLUSIONS: This is the first study to describe the surgical anatomy of the pudendal nerve in a population of patients with pudendal neuralgia. In more than 70% of cases, pudendal nerve entrapment was situated in the space between the sacrospinous ligament and the sacrotuberous ligament. Anatomical variants of the pudendal nerve were also observed in 13% of patients, sometimes with a transligamentous course of the nerve. In the light of these results, we believe that a transgluteal approach is the most suitable surgical approach for safe pudendal nerve decompression by allowing constant visual control of the nerve.Key words: Surgical, operative technique, pudendal, neuralgia, transgluteal approach.
John R Miklos - One of the best experts on this subject based on the ideXlab platform.
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vaginal repair of cystocele with anterior wall mesh via transobturator route efficacy and complications with up to 3 year followup
Advances in Urology, 2009Co-Authors: Robert D Moore, John R MiklosAbstract:Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the Ischial Spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3–36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up.
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Vaginal repair of cystocele with anterior wall mesh via transobturator route: efficacy and complications with up to 3-year followup,”
2009Co-Authors: Robert D Moore, John R MiklosAbstract:Recommended by Miroslav L. Djordjevic Study Objective. The objective of this study was to report on the safety and efficacy of cystocele repair with anterior wall mesh placed via a transobturator route (Perigee system, AMS, Minnetonka, MN). Design. Single center retrospective study. Setting. Single center hospital setting and Urogynecology practice in the United States. Patients. 77 women presenting with symptomatic anterior wall prolapse. Intervention. Repair of cystocele with an anterior wall Type I soft-polypropylene mesh placed via a transobturator approach. Concomitant procedures in other compartment were also completed as indicated. Measurements and Main Results. 77 women underwent the Perigee procedure at our institution over a 2-year period. The mesh was attached to the pelvic sidewalls at the level of the bladder neck and near the Ischial Spine apically with needles passed through the groins and obturator space. Mean follow-up was 18.2 months (range 3-36 months). Objective cure rate was 93%. Subjectively only two patients have had recurrent symptoms of prolapse, and only 1 of these has required repeat surgery for cystocele. Mesh exposure vaginally occurred in 5 patients (6.5%); however all were treated with estrogen and/or local excision of exposed mesh and had no further sequelae. There were no incidences of chronic pain, infection, or abscess, and no patient required complete mesh removal for infection, pain, or extrusion. Conclusion. In select patients with anterior wall prolapse, repair with mesh augmentation via the transobturator route is a safe and effective procedure with up to 3 years of follow-up
Rafael J Sierra - One of the best experts on this subject based on the ideXlab platform.
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Ischial Spine sign reveals acetabular retroversion in legg calve perthes disease
Clinical Orthopaedics and Related Research, 2011Co-Authors: Noelle A Larson, Anthony A Stans, Rafael J SierraAbstract:Acetabular retroversion has been identified in mature patients with sequelae of Legg-Calve-Perthes (LCP) disease. Whether this is a contributing etiologic factor that leads to the disease process or result of the head deformity is not known. The prominence of the Ischial Spine (PRIS) sign, which reflects retroversion, can be observed before ossification of the anterior and posterior walls in a skeletally immature patient and could help determine whether the retroverted acetabulum is present before or after head involvement in patients with LCP disease. We therefore determined (1) the prevalence of the PRIS sign in patients with LCP disease compared with healthy control subjects, (2) whether the PRIS sign is seen at the time of head involvement in patients with LCP disease, and (3) the prevalence of bilaterality of the PRIS sign in patients with LCP disease and control subjects. Of 295 patients with LCP disease, 47 (49 hips) met our inclusion criteria. Of these, 39 (41 hips) had open triradiate cartilage and comprised the study group. Twenty-five pediatric patients with polytrauma (50 hips) with standardized radiographs comprised the control group. A positive PRIS sign was noted in 37 of the 41 skeletally immature hips compared with only 16 of the 50 control hips. We observed a positive PRIS sign early in the LCP disease process with eight of nine patients in the fragmentation phase having a positive PRIS sign. The PRIS sign was seen bilaterally in 25 of 39 patients with unilateral LCP disease and in only five of 25 control patients. Acetabular retroversion, as evidenced by a positive PRIS, was present in nine of 10 children with LCP disease. It is uncertain if retroversion is a cause or a sequela of the disease, but it was seen early in the disease process at the time of head involvement in the majority of patients. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Ischial Spine projection into the pelvis a new sign for acetabular retroversion
Clinical Orthopaedics and Related Research, 2008Co-Authors: Fabian Kalberer, Rafael J Sierra, Sanjeev S Madan, Reinhold Ganz, Michael LeunigAbstract:Femoroacetabular impingement may occur in patients with so-called acetabular retroversion, which is seen as the crossover sign on standard radiographs. We noticed when a crossover sign was present the Ischial Spine commonly projected into the pelvic cavity on an anteroposterior pelvic radiograph. To confirm this finding, we reviewed the anteroposterior pelvic radiographs of 1010 patients. Nonstandardized radiographs were excluded, leaving 149 radiographs (298 hips) for analysis. The crossover sign and the prominence of the Ischial Spine into the pelvis were recorded and measured. Interobserver and intraobserver variabilities were assessed. The presence of a prominent Ischial Spine projecting into the pelvis as diagnostic of acetabular retroversion had a sensitivity of 91% (95% confidence interval, 0.85%–0.95%), a specificity of 98% (0.94%–1.00%), a positive predictive value of 98% (0.94%–1.00%), and a negative predictive value of 92% (0.87%–0.96%). Greater prominence of the Ischial Spine was associated with a longer acetabular roof to crossover sign distance. The high correlation between the prominence of the Ischial Spine and the crossover sign shows retroversion is not just a periacetabular phenomenon. The affected inferior hemipelvis is retroverted entirely. Retroversion is not caused by a hypoplastic posterior wall or a prominence of the anterior wall only and this finding may influence management of acetabular disorders. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Michael Leunig - One of the best experts on this subject based on the ideXlab platform.
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Ischial Spine projection into the pelvis a new sign for acetabular retroversion
Clinical Orthopaedics and Related Research, 2008Co-Authors: Fabian Kalberer, Rafael J Sierra, Sanjeev S Madan, Reinhold Ganz, Michael LeunigAbstract:Femoroacetabular impingement may occur in patients with so-called acetabular retroversion, which is seen as the crossover sign on standard radiographs. We noticed when a crossover sign was present the Ischial Spine commonly projected into the pelvic cavity on an anteroposterior pelvic radiograph. To confirm this finding, we reviewed the anteroposterior pelvic radiographs of 1010 patients. Nonstandardized radiographs were excluded, leaving 149 radiographs (298 hips) for analysis. The crossover sign and the prominence of the Ischial Spine into the pelvis were recorded and measured. Interobserver and intraobserver variabilities were assessed. The presence of a prominent Ischial Spine projecting into the pelvis as diagnostic of acetabular retroversion had a sensitivity of 91% (95% confidence interval, 0.85%–0.95%), a specificity of 98% (0.94%–1.00%), a positive predictive value of 98% (0.94%–1.00%), and a negative predictive value of 92% (0.87%–0.96%). Greater prominence of the Ischial Spine was associated with a longer acetabular roof to crossover sign distance. The high correlation between the prominence of the Ischial Spine and the crossover sign shows retroversion is not just a periacetabular phenomenon. The affected inferior hemipelvis is retroverted entirely. Retroversion is not caused by a hypoplastic posterior wall or a prominence of the anterior wall only and this finding may influence management of acetabular disorders. Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
