Exposure of the Sciatic Nerve in the Gluteal Region Without Sectioning the Gluteus Maximus: An Anatomical and Microsurgical Study

Author(s):  
Mariano Socolovsky ◽  
Lucas Garategui ◽  
Alvaro Campero ◽  
Horacio Conesa ◽  
Armando Basso
2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-165-ONS-171 ◽  
Author(s):  
Parag G. Patil ◽  
Allan H. Friedman

Abstract OBJECTIVE: To increase awareness among neurosurgeons of alternative surgical approaches to lesions of the sciatic nerve in the gluteal region. METHODS: The dominant surgical approach to lesions of the proximal sciatic nerve involves detachment and medial reflection of the gluteus maximus through a question-mark incision. An alternative to this infragluteal exposure is a transgluteal approach, which provides access to the sciatic nerve by splitting the gluteus maximus through a curvilinear incision. We explored the anatomy and surgical history of these approaches through cadaveric study, our own case series, and a literature review. RESULTS: The infragluteal approach uses a larger incision, extensive dissection, and postoperative bracing while allowing wide exposure of the nerve inferiorly into the thigh. By contrast, the transgluteal approach minimizes dissection and spares muscle attachments but requires meticulous attention to hemostasis and provides a more focal exposure of the sciatic nerve. During the past century, the infragluteal approach has been described more frequently and has become increasingly popular among peripheral-nerve surgeons. For comparison, we present three patients in whom the transgluteal approach was used to treat substantial lesions of the proximal sciatic nerve. CONCLUSION: At the present time, the majority of peripheral nerve surgeons use an infragluteal approach to the proximal sciatic nerve. However, for select patients with well-defined and localized lesions, the transgluteal approach may provide sufficient nerve exposure with lowered operative complexity and postoperative morbidity.


2021 ◽  
pp. 004947552098474
Author(s):  
Ravi Mittal ◽  
Siddharth Jain

Gluteus maximus contracture, characterised by contracture of gluteus maximus, iliotibial band and covering fascia, can be caused by repeated intramuscular injections in the gluteal region. It is amenable to open surgical release.


Author(s):  
Sonia Jandial

The sciatic nerve has a long course right from the pelvis to the apex of the popliteal fossa. The point of division of the sciatic nerve into tibial and common peroneal nerves is very variable. The variation in the division of the sciatic nerve described in the present study should be helpful for anaesthetists and orthopaedic surgeons. While doing the dissection and teaching of the gluteal region in the Post Graduate Department of Anatomy, government medical college, Jammu, it was found that on the left side tibial nerve and common peroneal nerve were present instead of sciatic nerve. It meant that the main nerve that is the sciatic nerve had already been divided into its terminal branches in the pelvis region. Both tibial and common peroneal nerve were seen coming out of the pelvis below the piriformis muscle, while on the right side there were no variation. The sciatic nerve was seen coming out of the pelvis below the piriformis muscle as usual. Because of this high division of the sciatic nerve in the pelvis, there are many complications like failed sciatic nerve block during anaesthesia while performing surgery, but high division of the sciatic nerve may result in escape of either tibial nerve or common peroneal nerve. The gluteal region, back of the thigh and leg of the lower limb were dissected to study further course of tibial nerve and the common peroneal nerve. Photographs were also taken.


2020 ◽  
Vol 34 (S1) ◽  
pp. 1-1
Author(s):  
Amarilis Camacho-Quiñones ◽  
Natalia Y. Cárdenas-Suárez ◽  
Marizabel La Puerta-Resto ◽  
Sofía Jimenez-Dietsch ◽  
Jailenne I. Quiñones-Rodríguez

2007 ◽  
Vol 21 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Effrossyni Georgakis ◽  
Roger Soames

2017 ◽  
Vol 14 (2) ◽  
pp. 281-286
Author(s):  
Andrew J. Kanawati ◽  
Rajpal Narulla ◽  
Peter Lorentzos ◽  
Edward Graham

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902110033
Author(s):  
Yunus Imren ◽  
Bulent Karslioglu ◽  
Suleyman Semih Dedeoglu ◽  
Haluk Cabuk ◽  
Sevgi Atar ◽  
...  

Background: The posterior approach (PA) is the most commonly used surgical approach for total hip arthroplasty (THA), but the proximity of the sciatic nerve may increase the likelihood of sciatic nerve injury (SNI). Gluteus maximus tenotomy can be performed to prevent SNI because tenotomy increases the distance between the femoral neck and sciatic nerve and prevents compression of the sciatic nerve by the gluteus maximus tendon (GMT) during hip movements. We aimed to kinematically compare the postoperative hip extensor forces of patients who have and have not undergone gluteus maximus tenotomy to determine whether there is a difference in hip extensor strength. Methods: Seventy-two patients who underwent gluteus maximus tenotomy during THA were included in the group 1, and 86 patients who did not undergo tenotomy were included in group 2. The Harris hip score, body mass index and hip extensor forces were measured both preoperatively, and 6 months after surgery with an isokinetic dynamometer and compared. Results: The mean age was 64.6 ± 2.3 years in group 1 and 63.8 ± 2.1 in group 2. Mean body mass index was 25.7 ± 1.1 in group 1, and 25.5 ± 1.3 in group 2. Baseline Harris hip score (HHS) was 42.36 ± 12 in group 1 and 44.07 ± 9.4 in group 2 (p = 0.31), whereas it was 89.1 ± 7.8 and 88.4 ± 8.1 at 6 months after surgery, respectively. Baseline hip extensor force (HEF) was 2 ± 0.4 Nm/kg in group 1, and 2.1 ± 0.7 Nm/kg in group 2 (p = 0.28), while it was 2.4 ± 0.6 Nm/kg, and 2.5 ± 0.5 Nm/kg, respectively at 6 month follow-up (p = 0.87). Both groups had significantly improved HHS and HEF when comparing baseline and postoperative measurements (p < 0.0001). No cases of sciatic nerve palsy were noted in group 1, whereas there were two (2.32%) cases in group 2, postoperatively. Conclusion: The release of the GMT during primary hip arthroplasty performed with the PA did not lead to significant decrease in hip extension forces. Hip extensor strength improves after THA regardless of tenotomy. Gluteus maximus tenotomy with repair does not reduce muscle strength and may offer better visualization.


2018 ◽  
Vol 08 (04) ◽  
pp. 168-174
Author(s):  
Kazuhiko Hashimoto ◽  
Kensuke Toriumi ◽  
Yukiko Hara ◽  
Shunki Iemura ◽  
Shunji Nishimura ◽  
...  

2020 ◽  
Vol 19 (4) ◽  
pp. 20-24
Author(s):  
T. Khmara

In the scientific literature, there are reports on the compression of the nerves of the sacral plexus of the pelvic area or above the gluteal fold in different age periods of a person's life. However, not enough attention is paid by morphologists to the options for the exit of the pudendal, superior and inferior gluteal neurovascular bundles and the sciatic nerve from the pelvic cavity in the perinatal period of human ontogenesis. To perform therapeutic and diagnostic manipulations, as well as surgical interventions in the gluteal region, accurate information is required about the projection-syntopic relationships of the pudendal, superior and lower gluteal neurovascular bundles and the sciatic nerve in human fetuses of different age groups. The study was carried out on 34 preparations of human fetuses, 186.0-310.0 mm parietococcygeal length. The material was fixed in a 7% formalin solution for two weeks, after which the topographic anatomical features of the muscles, blood vessels and nerves of the gluteal region in fetuses of 6-8 months were studied by fine dissection under the control of a binocular loupe. Human fetal preparations were received after artificial termination of pregnancy, which were carried out for social and medical reasons on the basis of district and city maternity hospitals. In 63.24% of the examined fetuses of 6-8 months, the projection of the superior gluteal vessels corresponds to the point located on the border between the upper and middle third osteocetabular line, less often (33.82% of observations) - downward (by 1.5-4, 3 mm) and medially (2.0-4.5 mm) from the specified point, and as an exception (only 3%) - 5.0-5.5 mm laterally from this point. The superior sciatic nerve is located 1.0-3.8 mm lateral to the vessels of the same name. In 75.01% of cases, the lower gluteal vessels leave the pelvis medially (by 2.0-4.7 mm) and down (by 1.5-4.2 mm) from the middle of the osteo-hump line. In 17.64% of observations, the projection of the lower gluteal vessels corresponds to the middle of the osteo-hump line, and in 7.35% of the fetuses, the projection of these vessels is determined 2.5-3.4 mm outward from the point located in the middle of the osteo-hump line. The sciatic nerve leaves the pelvis mainly (75% of observations) medially (2.0-5.4 mm) from the middle of the hump-acetabular line, and in 25% of cases the projection of the sciatic nerve corresponds to the middle of this line.


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