Communications of the lumbar plexus with the sacral plexus in primates.
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Animals↗
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Results for “SACRAL PLEXUS”
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[Morphology of the sacral plexus and its nerves in domestic cattle (Bos primigenius f. taurus L., 1758). I. Morphology of the sacral plexus].
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Animals↗
[Morphology of the sacral plexus and its nerves in domestic cattle (Bos primigenius f. taurus L., 1758). II. Morphology of the sacral plexus innervation].
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Animals↗
MR imaging of the sacral plexus: normal findings.
Imaging of the sacral plexus requires evaluation of both intradural and extradural components with cross-sectional techniques. Although CT is useful, individual extradural sacral nerves and the sacral plexus usually cannot be distinguished from adjacent structures. The higher contrast resolution provided by MR imaging allows the region of the sacral plexus to be examined in greater detail. With MR imaging, the constant relationship of the neural components to one another, and the gluteal vessels in their course from the sacrum to the greater sciatic foramen, can be shown consistently. An understanding of the anatomy of this area in multiple planes can aid in more accurate localization of abnormalities involving the sacral plexus. This pictorial essay reviews the MR appearance of the region of the sacral plexus.
Cadaver↗
[The posterior sacral plexus].
The posterior sacral branches, when connecting, form the posterior sacral plexus and its terminal branch, the posterior gluteal nerve that we suggest be called the inter-gluteal nerve because of its course and territory. Apart from their anatomic interest, their lesions can explain some neuralgias in sacrococcygeal attacks.
Back Pain↗
Electrophysiological evidence for the nomenclature of the pudendal nerve and sacral plexus in the male rat.
Surgical microscopy and electrophysiological techniques were used to standardize the nomenclature for the pudendal nerve and sacral plexus according to their somatic axonal composition in the male rat. We conclude that the pudendal nerve is the segment running from the L6-S1 trunk to the sacral plexus, carrying efferent fibers to the coccygeus, internal obturator, ventral and dorsal bulbospongiosus, ischiocavernosus, external anal sphincter, and external urethral sphincter muscles, and afferent fibers from the penis, prepuce, scrotum, and ventral-proximal tail. The sacral plexus is the complex formed by the bridge-like structure connecting the pudendal nerve with the lumbosacral trunk, and two nerve branches emerging from it, one innervating the proximal half of the scrotal skin, and the other innervating the muscles at the base of the penis known as the motor branch. These branches are only considered as a part of the sacral plexus because they integrate axons from both the lumbosacral trunk and pudendal nerve. The gross anatomy of the pudendal nerve and sacral plexus has a main organization that was observed in 70% of cases, whereas the remaining 30% occurred in two variants. This nomenclature is appropriate to describe the pudendal nerve and sacral plexus in studies that involve them being lesioned or electrophysiologically analysed. A main additional finding was that two large afferent branches innervate the scrotum, one the proximal half and the other the distal half. As mentioned above, the proximal branch belongs to the sacral plexus, whereas the distal branch belongs to the pudendal nerve because all its axons travel to the cord via this nerve. Since stimulation or even manipulation of the scrotal branches resulted in the secretion of semen containing spermatozoa, it is suggested that scrotal afferents are involved in some way in the ejaculatory process, a topic that deserves further research.
Animals↗
Computed tomography of the sacral plexus and sciatic nerve in the greater sciatic foramen.
The sacral plexus forms the sciatic nerve, which leaves the pelvis through the greater sciatic foramen. The anatomic boundaries of the greater sciatic foramen and the relation of the sacral plexus and sciatic nerve to the structures within are identified and described on axial computed tomography (CT). The piriform muscle, which passes through the center of the greater sciatic foramen, is a recognizable landmark that is extremely helpful in locating the sacral plexus and sciatic nerve on CT. The pelvic CT images of 25 patients studied for unrelated reasons and two patients studied for complaints related to the greater sciatic foramen were reviewed. CT was very useful in demonstrating the anatomy of this region and for the investigation of sciatic pain due to lesions outside the neural canal.
Humans↗
MR imaging of the sacral plexus: abnormal findings.
Patients with symptoms of sacral plexopathy, radiculopathy, or sciatica may have disease originating in the neural elements, sacrum, bony pelvis, pelvic soft tissues, or gluteal region. As illustrated in our companion article, the sacral plexus and surrounding structures can be visualized in detail with MR imaging. This pictorial essay illustrates the MR findings in a number of abnormalities affecting the sacral plexus. Multiplanar MR examination is particularly helpful in defining neural levels of involvement by disease in this region.
Abscess↗
Interconnections of the upper ventral rami of the human sacral plexus: a reappraisal for dorsal rhizotomy in neurostimulation operations.
The extension of a dorsal rhizotomy in bladder stimulation patients is partly determined by connections between the ventral rami of the second, third, and fourth sacral spinal nerves. The literature is inconclusive on interconnections of these ventral rami in the human sacral plexus. The sacral plexuses of ten human cadavers were dissected in this gross anatomy study. In nine cases a branch connecting the ventral rami of the second and third sacral spinal nerves was found. Electron microscopy demonstrated the presence of thick myelinated fibers in this branch. In the male plexuses this branch formed the only link between the second sacral spinal segment and the pelvic plexus. The ventral ramus of the second sacral nerve always contributed to the pudendal nerve, whereas involvement of the ventral rami of the first and third sacral nerves differed individually and intersexually.
Female↗
Stratificational relationship among the main nerves from the dorsal division of the sacral plexus and the innervation of the piriformis.
In order to comprehend more completely the morphology of the nerves to the piriformis, it is necessary to obtain a detailed understanding of the relationship of the origin and the course of these nerves from the dorsal division of the sacral plexus, with reference to the superior and inferior gluteal nerves. Twelve of seven human pelvic halves were carefully dissected in order to examine the origins of the nerves from the dorsal division of the sacral plexus. Six of these pelvic halves were further dissected under a stereomicroscope to examine the nerves to the piriformis. 1. The origin of the superior gluteal nerve was more proximal and dorsal in the sacral plexus than that of the inferior gluteal nerve. 2. The superior gluteal nerve consisted of a thick cranial part and a thin caudal part; the former continued as the inferior branch of the nerve, and the latter, the superior branch. The cranial and caudal parts crossed before reaching the glutei medius and minimus. 3. The nerves to the piriformis arose from three main nerves from the dorsal division of the sacral plexus: 1) the caudalmost root of the superior gluteal nerve, 2) the caudal roots of the inferior gluteal nerve and 3) the common peroneal nerve. Considering the stratificational relationship among the main nerves from the dorsal division of the sacral plexus, the piriformis appears to be composed of parts from different muscle layers.
Buttocks↗
Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve.
We describe the anatomy of the uterosacral ligament with respect to the sacral plexus. In six adult female embalmed cadavers, we identified the uterosacral ligament and its lateral nerve relations. Using the ischial spine as the starting point and measuring along the axis of the uterosacral ligament, we noted that the S1 trunk of the sacral plexus passes under the ligament 3.9 cm [95% confidence interval (CI), 2.1-5.8 cm] superior to the ischial spine. The S2 trunk passes under the ligament at 2.6 cm (95% CI; 1.5, 3.6 cm), the S3 trunk passes under the ligament at 1.5 cm (95% CI; 0.7, 2.4 cm), and the S4 trunk passes under the ligament at 0.9 cm (95% CI; 0.3, 1.5 cm) superior to the ischial spine. The pudendal nerve forms lateral to the uterosacral ligament. Our data demonstrate that the S1-S4 trunks of the sacral plexus, not the pudendal nerve, are vulnerable to injury during uterosacral ligament suspension.
Female↗
Percutaneous retroperitoneal stimulation of the sacral plexus. Initial report and technical note.
A new percutaneous approach to stimulate the sacral plexus for the treatment of pain is described. The percutaneous electrode is inserted under fluoroscopy through the chosen dorsal and ventral sacral foramen and is advanced into the retroperitoneal layer where the plexus lies. The electrode, can be advanced several centimeters and lies in close proximity to the branches of the sacral plexus. Both motor and sensory responses can be elicited with electrical stimulation. Our initial experience with 4 implanted patients is presented and discussed. Several areas of the nervous system have been target for implantation of stimulating and recording electrodes for management of pain, as well as other indications. This includes parts of the cerebrum, brainstem, spinal cord and peripheral nerves. We report our initial experience with a new approach to stimulation of the peripheral nervous structures. That is stimulation of the sacral plexus through electrodes implanted percutaneously along the plexus in the retroperitoneal area. This initial report is not meant to give clinical results of this methodology, but simply to point to another route to apply electrical stimulation safely to various parts of the nervous system.
Analgesia↗
Nerve sheath tumors of the sciatic nerve and sacral plexus.
Eight patients with sciatic nerve and sacral plexus nerve sheath tumors, seen at Louisiana State University Medical Center in Shreveport, are presented. These cases illustrate the broad spectrum of pathology and modes of presentation of patients with nerve sheath tumors in this region. Patients can be divided into 4 groups. Group I includes subgluteal and/or thigh lesions with a well-defined mass on CT. Group II patients have neuroforaminal enlargement (defined by CT) and usually have radicular leg pain. Patients in group III have intrapelvic tumors with extension into the thigh. They usually have a poorly defined mass on CT. Group IV includes patients that have an intrapelvic mass (usually well defined) with radicular leg pain and/or mass effect. CT scanning proved to be the diagnostic procedure of choice. It delineated the location and extent of the tumor and thus was important in determining resectability. The variable course of these tumors is emphasized. A conservative nonoperative approach should be considered in asymptomatic and/or neurologically stable patients.
Adult↗
An anatomical analysis of the dorsoventral relationship between the sacral plexus and the pudendal nerve in man by use of computer aided three-dimensional reconstruction.
In order to investigate the dorsoventral relationship between the sacral plexus and the pudendal nerve in man, morphological examination was performed on one pelvic half of a male cadaver. The second and third spinal nerves were removed en bloc and sectioned serially for three-dimensional reconstruction imaging of the selected sections. Comparison of the sequential images revealed that the root of the pudendal nerve is first situated ventral to the caudal root of the sacral plexus, and that the former and the latter are shifted cranialward and caudalward, respectively, at the point of exit from the second anterior sacral foramen.
Humans↗
MRI of lumbar and sacral plexus nerve sheath tumours.
Seven patients with peripheral nerve sheath tumours affecting the lumbo-sacral plexus were examined with MR imaging utilizing a 1.5T magnet and spin echo pulse sequences. The majority of tumours were homogeneous in signal intensity and isointense with adjacent muscle on T1 weighted images and showed markedly increased signal intensity on T2 weighted images with central areas of relatively low signal intensity. An attempt to obtain a pathological correlation with the areas of low signal on T2 weighted images was unsuccessful. The use of Gadolinium DTPA in one patient resulted in irregular enhancement of both a neurogenic sarcoma and smaller neurofibromas. The multiplanar imaging capabilities, high soft tissue contrast, non-invasiveness, lack of ionizing radiation and the characteristic appearance of neural tumours makes MR ideal for imaging these lesions.
Adult↗
Sacral plexus nerve sheath tumor: case report.
A young woman with chronic sciatica was found to have an intrapelvic sacral plexus nerve sheath tumor. Computed tomography of the pelvis was used to delineate this unusual site of tumor development. The case report and a discussion of pelvic nerve sheath tumors are presented.
Adult↗
Sacral plexus: optimal imaging planes for MR assessment.
PURPOSE: To identify the optimal imaging planes for magnetic resonance (MR) evaluation of the sacral plexus (SP) and proximal sciatic nerve (SN). MATERIALS AND METHODS: The SPs of 10 health adult volunteers were prospectively studied with T1-weighted MR imaging with custom-built pelvic phased-array coils. The conspicuity of 12 anatomic characteristics (comprising the SP and their relationship to normal pelvic anatomy) on a series of coronal, axial, and oblique images was graded. Results were evaluated with the Kruskal-Wallis and Wilcoxon signed rank tests. RESULTS: At least two planes were necessary to assess the anatomy of the SP and SN. Analysis of average conspicuity scores showed that the direct coronal and direct axial planes were the best overall and were superior to other imaging planes in the demonstration of the L-4 and L-5 ventral rami, the lumbosacral trunk, the S-1 contribution to the SN, and the SN in the greater sciatic foramen. The sacral coronal plane was best for the visualization of the bony sacrum, sacral foramina, and proximal S-1 to S-4 nerve roots. The remaining imaging planes had limited utility. CONCLUSION: MR imaging with a combination of direct coronal and direct axial planes enables thorough evaluation of all components of the SP and proximal SN.
Adult↗
[Lumbo-sacral plexus neuropathy induced by irradiation (author's transl)].
We report the case of a 60 year-old woman who developed a slowly progressive retrograde diplegia of the lumbo-sacral plexus with mixed sensomotor losses. This occurred with a delay of 6 years after telecobalt irradiation of a pelvic squamous cell carcinoma. Extensive investigations regarding the possibility of tumour recurrence were negative. This case report is compared with the few cases of irradiation damage to peripheral nerves or nerve roots of the lumbo-sacral area published until now.
Carcinoma, Squamous Cell↗