Sacral Plexus

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Peter R. Luijten - One of the best experts on this subject based on the ideXlab platform.

Y Tang - One of the best experts on this subject based on the ideXlab platform.

  • esra19 0046 ultrasound guided t12 paravertebral block combined with l1 4 nerve roots block and Sacral Plexus block for hip surgery a case series
    Regional Anesthesia and Pain Medicine, 2019
    Co-Authors: D Zhao, Y Tang
    Abstract:

    Background and aims Hip surgery is commonly seen in aged patients. Anesthesia management for them is challenging; the selection of anesthesia method will have influence on the prognosis and life quality of patients. Ultrasound-guided T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block introduced in this paper. We have conducted this anesthesia on 4 aged patients who had accepted the total hip arthroplasty, all operations were finished successfully. Methods Four aged patients were scheduled for total hip arthroplasty. All of them suffer from various kinds of systemic diseases, have a weak cardio-pulmonary function, and are subject to multiple complications and high risks during analgesia and operations. Ultrasound-guided T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block was successfully used for the surgery. Results All operations were finished successfully, no opioid drugs or other sedation and analgesia drugs were used during the operations, and the patients had no discomfort. Conclusions T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block can completely block the motion, feeling and sympathetic nerve of the hip joint, and provide a safe and effective anesthesia method for elderly patients who receive hip surgery.

  • ESRA19-0046 Ultrasound-guided T12 paravertebral block combined with L1–4 nerve roots block and Sacral Plexus block for hip surgery: a case series
    E-Poster Viewing Abstracts, 2019
    Co-Authors: D Zhao, Y Tang
    Abstract:

    Background and aims Hip surgery is commonly seen in aged patients. Anesthesia management for them is challenging; the selection of anesthesia method will have influence on the prognosis and life quality of patients. Ultrasound-guided T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block introduced in this paper. We have conducted this anesthesia on 4 aged patients who had accepted the total hip arthroplasty, all operations were finished successfully. Methods Four aged patients were scheduled for total hip arthroplasty. All of them suffer from various kinds of systemic diseases, have a weak cardio-pulmonary function, and are subject to multiple complications and high risks during analgesia and operations. Ultrasound-guided T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block was successfully used for the surgery. Results All operations were finished successfully, no opioid drugs or other sedation and analgesia drugs were used during the operations, and the patients had no discomfort. Conclusions T12 paravertebral block combined with L1-4 nerve roots block and Sacral Plexus block can completely block the motion, feeling and sympathetic nerve of the hip joint, and provide a safe and effective anesthesia method for elderly patients who receive hip surgery.

Alexander Leemans - One of the best experts on this subject based on the ideXlab platform.

  • Diffusion Tensor Magnetic Resonance Imaging and Fiber Tractography of the Sacral Plexus in Children with Spina Bifida
    The Journal of urology, 2014
    Co-Authors: Wieke Haakma, Martijn Froeling, Bennie Ten Haken, Rutger A. J. Nievelstein, Pieter Dik, Inge Cuppen, Tom P.v.m. De Jong, Alexander Leemans
    Abstract:

    Purpose: It is still largely unknown how neural tube defects in spina bifida affect the nerves at the level of the Sacral Plexus. Visualizing the Sacral Plexus in 3 dimensions could improve our anatomical understanding of neurological problems in patients with spina bifida. We investigated anatomical and microstructural properties of the Sacral Plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography.Materials and Methods: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system. Anatomical 3-dimensional reconstructions were obtained of the Sacral Plexus of the 10 patients. Fiber tractography was performed with a diffusion magnetic resonance imaging toolbox to determine fractional anisotropy, and mean, axial and radial diffusivity in the Sacral Plexus of the patients. Results were compared to 10 healthy controls.Results: Nerves of patients with spina bifida showed asymmetry and disorganization to a ...

  • architectural configuration and microstructural properties of the Sacral Plexus a diffusion tensor mri and fiber tractography study
    NeuroImage, 2012
    Co-Authors: Pasquelle K N Van Der Jagt, Martijn Froeling, Thomas C Kwee, Bennie Ten Haken, Rutger A. J. Nievelstein, Alexander Leemans
    Abstract:

    The ability to investigate microstructural properties of the central nervous system with diffusion tensor imaging (DTI) has been shown in many studies. More recently, DTI is being applied outside the brain showing promising results, for instance, for investigating muscle tissue. In this work, we demonstrate the feasibility of diffusion tensor imaging (DTI) and fiber tractography to study the nerves of the Sacral Plexus in humans in vivo and to assess the architectural configuration and microstructural properties of these peripheral nerves. For this research goal we optimized the acquisition parameters of a DTI sequence and acquired data from 10 healthy adults and one 12-year patient having spina bifida and neurogenic bladder dysfunction. For the healthy volunteers, we estimated the fractional anisotropy (FA) and mean (MD), axial (AD), and radial diffusivities (RD) of the Sacral Plexus nerves which may serve as a baseline for future studies. We demonstrated that tractography of the Sacral Plexus on a 3 Tesla MR scanner is feasible, giving 3D insight in the general anatomy and organization of the nerves L4 to S3. In addition, branches to the pudendal nerve were also found in 4 volunteers. There were no significant differences in any of the estimated diffusion measures between the right and left sided nerves or between the nerves L4 to S3 on an intra-subject basis. Furthermore, clinical feasibility of DTI and tractography in a child having spina bifida and neurogenic bladder dysfunction is demonstrated. The architectural configuration of the child's Sacral Plexus was comparable with the healthy volunteers and no significant disrupted nerve fibers were observed. However, there are strong indications that abnormal diffusion characteristics are present at the level of the neural tube defect due to incomplete segments of the nerves that are close to the vertebrae. These findings are encouraging for using DTI as a means to investigate changes in microstructural properties of the nerves of the Sacral Plexus. Moreover, this new methodology may provide a new avenue to a better analysis and diagnosis of neurogenic bladder dysfunctions

Thomas C Kwee - One of the best experts on this subject based on the ideXlab platform.

  • architectural configuration and microstructural properties of the Sacral Plexus a diffusion tensor mri and fiber tractography study
    NeuroImage, 2012
    Co-Authors: Pasquelle K N Van Der Jagt, Martijn Froeling, Thomas C Kwee, Bennie Ten Haken, Rutger A. J. Nievelstein, Alexander Leemans
    Abstract:

    The ability to investigate microstructural properties of the central nervous system with diffusion tensor imaging (DTI) has been shown in many studies. More recently, DTI is being applied outside the brain showing promising results, for instance, for investigating muscle tissue. In this work, we demonstrate the feasibility of diffusion tensor imaging (DTI) and fiber tractography to study the nerves of the Sacral Plexus in humans in vivo and to assess the architectural configuration and microstructural properties of these peripheral nerves. For this research goal we optimized the acquisition parameters of a DTI sequence and acquired data from 10 healthy adults and one 12-year patient having spina bifida and neurogenic bladder dysfunction. For the healthy volunteers, we estimated the fractional anisotropy (FA) and mean (MD), axial (AD), and radial diffusivities (RD) of the Sacral Plexus nerves which may serve as a baseline for future studies. We demonstrated that tractography of the Sacral Plexus on a 3 Tesla MR scanner is feasible, giving 3D insight in the general anatomy and organization of the nerves L4 to S3. In addition, branches to the pudendal nerve were also found in 4 volunteers. There were no significant differences in any of the estimated diffusion measures between the right and left sided nerves or between the nerves L4 to S3 on an intra-subject basis. Furthermore, clinical feasibility of DTI and tractography in a child having spina bifida and neurogenic bladder dysfunction is demonstrated. The architectural configuration of the child's Sacral Plexus was comparable with the healthy volunteers and no significant disrupted nerve fibers were observed. However, there are strong indications that abnormal diffusion characteristics are present at the level of the neural tube defect due to incomplete segments of the nerves that are close to the vertebrae. These findings are encouraging for using DTI as a means to investigate changes in microstructural properties of the nerves of the Sacral Plexus. Moreover, this new methodology may provide a new avenue to a better analysis and diagnosis of neurogenic bladder dysfunctions

  • Diffusion-weighted MR neurography of the Sacral Plexus with unidirectional motion probing gradients
    European Radiology, 2010
    Co-Authors: Taro Takahara, Thomas C Kwee, Jeroen Hendrikse, Tomohiro Yamashita, Marc Cauteren, Daniel Polders, Vincent Boer, Yutaka Imai, Willem P. Th. M. Mali, Peter R. Luijten
    Abstract:

    Background This technical note introduces diffusion-weighted (DW) MR neurography (MRN) of the Sacral Plexus with unidirectional motion probing gradients (MPGs). Methods This is compared with DW MRN with three-directional and six-directional MPGs. Results and conclusion This paper indicates that DW MRN of the Sacral Plexus should be performed with unidirectional MPGs.

  • Diffusion-weighted MR neurography of the Sacral Plexus with unidirectional motion probing gradients.
    European radiology, 2009
    Co-Authors: Taro Takahara, Thomas C Kwee, Jeroen Hendrikse, Tomohiro Yamashita, Daniel Polders, Yutaka Imai, Willem P. Th. M. Mali, Marc Van Cauteren, Vincent O. Boer, Peter R. Luijten
    Abstract:

    Background This technical note introduces diffusion-weighted (DW) MR neurography (MRN) of the Sacral Plexus with unidirectional motion probing gradients (MPGs).

Marc Possover - One of the best experts on this subject based on the ideXlab platform.

  • laparoscopic therapy for endometriosis and vascular entrapment of Sacral Plexus
    Fertility and Sterility, 2011
    Co-Authors: Marc Possover, Thilo Schneider, Klauspeter Henle
    Abstract:

    Objective To report our experience with endopelvic causes for Sacral radiculopathies and sciatica. Design Prospective cohort study. Setting Tertiary referral advanced laparoscopic gynecology and neuropelveologic unit. Patient(s) Two hundred thirteen women who underwent laparoscopic management of Sacral radiculopathy (sciatica, pudendal, gluteal pain) of unknown genesis in the period between November 2004 and February 2010. Intervention(s) Selective, clinically oriented, laparoscopic exploration of the Sacral Plexus with nerve decompression. Main Outcome Measure(s) Complication rates and the short-term cure at 6-month follow-up with use of the Visual Analogue Scale. Result(s) Laparoscopic exploration showed isolated endometriosis of the sciatic nerve in 27 patients, deeply infiltrating parametric endometriosis with Sacral Plexus infiltration in 148 patients, Sacral Plexus vascular entrapment in 37 patients, and pyriformis syndrome in one patient. A reduction in mean ± SEM) Visual Analogue Scale score of patient pain from 7.7 (± 1.16; range 6–10) before surgery to 2.6 (± 1.77; range 0–6) at 6-month follow-up was obtained for Sacral Plexus endometriosis and from 6.6 (± 1.43; range 5–9) to 1.5 (± 1.27; range 0–4) for vascular entrapment. Conclusion(s) In patients with chronic pelvic pain, preoperative anamnesis and examination should include evaluation of symptoms of Sacral radiculopathies (pudendal, gluteal pain) and sciatic neuralgia. In patients with Sacral radiculopathy or sciatica of unknown genesis, suspicion of endopelvic pathology such as endometriosis or vascular entrapment must be raised, and laparoscopic exploration of the Sacral Plexus and/or sciatic nerve is then advisable.

  • New surgical evolutions in management of Sacral radiculopathies.
    Surgical technology international, 2010
    Co-Authors: Marc Possover
    Abstract:

    Abstract Neurophysiological investigations and neurosurgical procedures of the Sacral Plexus are not especially well developed, because the Sacral Plexus is difficult to access. Awareness that Sacral radiculopathies may exist is still lacking and the incidence of these pathologies is widely underestimated. Since the recent introduction of laparoscopy in the field of pelvic nerves, the situation has changed considerably: laparoscopy not only permits a precise morphological and functional exploration of the entire Sacral Plexus, but also offers new therapeutic options: In lesions to the Sacral nerve roots by compression, infiltration, or surgical damages, the laparoscopy offers an adequate access for micro-neurosurgical procedures; whereas in neurogenic pathologies or situations of failure of neurosurgical treatments, the technique of laparoscopic implantation of a neuroprosthesis - the LION procedure - permits the neuromodulation of all Sacral nerve roots in different combination with only one electrode for simultaneous control of pelvic/lower limb pain and pelvic visceral dysfunctions. Regarding the dramatically increased incidence of Sacral radiculopathies, especially secondary to pelvic prolaps surgeries by blind mesh-material implantation, this field of pathologies has to come in the focus of medical interests. Also, physicians involved in pelvic pathologies/surgeries have to be trained in clinical neuropelveology.

  • The laparoscopic implantation of neuroprothesis to the Sacral Plexus for therapy of neurogenic bladder dysfunctions after failure of percutaneous Sacral nerve stimulation.
    Neuromodulation : journal of the International Neuromodulation Society, 2009
    Co-Authors: Marc Possover
    Abstract:

    Objectives:  To report about our first short series of laparoscopic implantation of neuroprothesis—LION procedure—to the Sacral Plexus for treatment of different neurogenic bladder dysfunctions in patients in whom percutaneous Sacral nerve stimulation (SNS) failed. Material and Methods:  A unilateral Sacral LION procedure was performed in four patients with a refractary interstitial cystitis, in 13 patients with refractory bladder overactivity (multiple sclerosis N= 8, spina bifida N= 1, incomplete paraplegia N= 2, diabetic cystopathy N= 1), one patient with a neurogenic bladder incontinence by Parkinson syndrome, and in four patients for treatment for bladder atonia (Fowler's syndrome). In all patients, not only previous medical treatments but also SNS by transforaminal implantation had failed. Laparoscopic exposure of the Sacral nerves roots S2 to S4/5 is performed by a transperitoneal approach and a quad electrode is placed perpendicular to the Sacral nerve roots for postoperative global stimulation of these Sacral nerve roots. Results:  All procedures were performed successfully by laparoscopy without any complications. The mean operative time for such a procedure was 34 min. In two patients of the series postoperative neuromodulation failed. In all further 19 patients with an actual follow-up varying between three months and three years, neuromodulation is still working successfully. Conclusions:  Our results underscore that the Sacral LION procedure to the Sacral Plexus is effective and safe for treatment divers neurogenic bladder dysfunctions even after failure of the classical percutaneous technique of implantation.

  • Laparoscopic Management of Endopelvic Etiologies of Pudendal Pain in 134 Consecutive Patients
    The Journal of urology, 2009
    Co-Authors: Marc Possover
    Abstract:

    Purpose: The feasibility of the laparoscopic transperitoneal approach to the pelvic somatic nerves was determined for the diagnosis and treatment of anogenital pain caused by pudendal and/or Sacral nerve root lesions.Materials and Methods: The records of 134 consecutive patients who underwent laparoscopy for refractory anogenital pain were retrospectively reviewed. All neurosurgical procedures, such as neurolysis/decompression of the pudendal nerve and the Sacral nerve roots or neuroelectrode implantation to the Sacral Plexus for postoperative neuromodulation, were done via the laparoscopic transperitoneal approach to the pelvic nerves.Results: A total of 18 patients had Alcock's canal syndrome and decompression was successful in 15. Due to failed decompression 3 patients underwent secondary Sacral laparoscopic neuroprosthesis implantation with a decrease of at least 50% on the pain visual analog scale. Sacral Plexus lesions or radiculopathies, most commonly postoperative lesions and retroperitoneal endom...

  • laparoscopic neurolysis of the Sacral Plexus and the sciatic nerve for extensive endometriosis of the pelvic wall
    Minimally Invasive Neurosurgery, 2007
    Co-Authors: Marc Possover, J Baekelandt, C Flaskamp, V Chiantera
    Abstract:

    BACKGROUND: The aim of this study is to report on the feasibility of laparoscopic neurolysis of the Plexus Sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall. METHODS: A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion. RESULTS: We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the Sacral Plexus at different levels. CONCLUSION: In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.