scholarly journals Anatomy of sciatic nerve bifurcation in popliteal fossa: a fetal study

2014 ◽  
Vol 31 (04) ◽  
pp. 199-201
Author(s):  
M. Sinha ◽  
R. Gupta ◽  
A. Aggarwal ◽  
D. Sahni ◽  
H. Sinha
Keyword(s):  
Sciatic Nerve ◽  
Quantitative Data ◽  
Tibial Nerve ◽  
Early Period ◽  
Popliteal Fossa ◽  
Gluteal Region ◽  
Lateral Condyle ◽  
Significant Implication ◽  
Fibular Nerve ◽  
Common Fibular Nerve

Abstract Background: We studied the bifurcation of sciatic nerve into two components which change their position throughout the early period of life. We proposed dimensions that would help reducing failure rates of anesthesia in popliteal fossa region and screening of malignancy related to sciatic nerve. Methods: The back of thigh and popliteal fossa of both sides of 50 fetuses (24 male and 26 female) were dissected. Skin over the gluteal region was dissected upto back of the knee. Sciatic nerve was traced from gluteal region to back of the thigh. The level where common fibular nerve and tibial nerve diverge from sciatic nerve and the diameter of sciatic nerve at various levels were evaluated. Results: In 97.7% (41/42) specimens,the bifurcation was above (5.1-20.86 mm) and in 2.3% (1/42) specimens, it was below (2.37 mm) the lateral condyle of femur. In 66% cases, sciatic nerve splits into two at or within 11 mm proximal to lateral condyle, while in 75% cases within 13mm, and in 100% cases within 21mm proximal to lateral condyle. Conclusion: This study provides quantitative data about the sciatic nerve in the gluteal region and back of the thigh. This data has a significant implication in diagnostic and anesthetic practice.

Proximal Motor Branches From the Tibial Nerve as Direct Donors to Restore Function of the Deep Fibular Nerve for Treatment of High Sciatic Nerve Injuries: A Cadaveric Feasibility Study

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons218-ons225 ◽  
Author(s):  
Leandro Pretto Flores
Keyword(s):  
Sciatic Nerve ◽  
Soleus Muscle ◽  
Tibial Nerve ◽  
Popliteal Fossa ◽  
Nerve Injuries ◽  
Medial Head ◽  
First Choice ◽  
The Common ◽  
Fibular Nerve ◽  
Common Fibular Nerve

Abstract Objective: The results of surgical repair of the fibular division of the sciatic nerve have been considered unsatisfactory, especially if grafts are necessary to reconstruct the nerve. To consider the clinical application of the concept of distal nerve transfer for the treatment of high sciatic nerve injuries, this study aimed to determine detailed anatomic data about the possible donor branches from the tibial nerve that are available for reinnervation of the deep fibular nerve at the level of the popliteal fossa. Methods: An anatomic study was performed that included the dissection of the popliteal fossa in 12 lower limbs of 6 formalin-fixed adult cadavers. It focused on the detailed anatomy of the tibial nerve and its branches at the level of the proximal leg as well as the anatomy of the common fibular nerve and its largest divisions at the level of the neck of the fibula, i.e., the deep and superficial fibular nerves. Results: The branches of the tibial nerve destined to the lateral and medial head of the gastrocnemius had a mean length of 43 mm and 35 mm, respectively. The branch to the posterior soleus muscle had a mean length of 65 mm. Intraneural dissection of the common fibular nerve, isolating its deep and superficial fibular divisions, was possible to a proximal mean distance of 71 mm. A tensionless direct suture to the deep fibular nerve was made possible by using the nerve to the lateral head of the gastrocnemius and the nerve to the posterior soleus muscle in all specimens. Direct suture of the nerve to the medial head of the gastrocnemius was possible in all cases except 1. Conclusion: The nerve to the lateral and medial heads of the gastrocnemius and the nerve to the posterior soleus muscle can be used as donors to restore function of the deep fibular nerve in cases of high sciatic nerve injury. However, proximal intraneural dissection of the deep fibular division of the common fibular nerve must also be performed. We recommend that the nerve to the posterior soleus muscle should be the first choice for a donor in the proposed transfer.

scholarly journals Unilateral higher division of sciatic nerve and its clinical importance

2019 ◽  
Vol 8 (1) ◽  
pp. 355
Author(s):  
Sonia Jandial
Keyword(s):  
Sciatic Nerve ◽  
Coming Out ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Clinical Importance ◽  
Common Peroneal Nerve ◽  
Gluteal Region ◽  
Piriformis Muscle ◽  
Long Course ◽  
The Right

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.

scholarly journals Tibial and Common Fibular Nerve Block in the Popliteal Fossa with Single Puncture Using Percutaneous Nerve Stimulator: Anatomical Considerations and Ultrasound Description

2011 ◽  
Vol 61 (5) ◽  
pp. 533-543
Author(s):  
Viviane de Oliveira Rangel ◽  
Raphael de Almeida Carvalho ◽  
Beatriz Lemos da Silva Mandim ◽  
Rodrigo Rodrigues Alves ◽  
Roberto Araújo Ruzi ◽  
...  
Keyword(s):  
Nerve Block ◽  
Popliteal Fossa ◽  
Nerve Stimulator ◽  
Fibular Nerve ◽  
Common Fibular Nerve

scholarly journals Electrophysiological patterns of sciatic nerve in patients with arthrosis deformans of the hip

2021 ◽  
Vol 28 (2) ◽  
pp. 47-54
Author(s):  
Vladimir V. Ostrovskij ◽  
Galina A. Korshunova ◽  
Sergey P. Bazhanov ◽  
Andrey A. Chekhonatskij ◽  
Vladimir S. Tolkachev
Keyword(s):  
Sciatic Nerve ◽  
Hip Replacement ◽  
Tibial Nerve ◽  
Neurological Complications ◽  
Post Surgery ◽  
Age Related ◽  
Significant Difference ◽  
Electrophysiological Findings ◽  
Arthrosis Deformans ◽  
Fibular Nerve

BACKGROUND: Neurological complications in sciatic nerve (SN) after a total hip replacement (THR) are observed in 0.93.2% of cases in patients with arthrosis deformans and age-related morphologic changes in SN. These cause the need for SN evaluation before THR. This research was aimed at the evaluation of the initial SN capacity with electrophysiological findings in patients with arthrosis deformans of the hip. MATERIALS AND METHODS: Electroneuromyography (ENMG) was used to evaluate fibular and tibial nerves M-responses as well as F-waves in 66 patients with dysplastic coxarthrosis and 12 patients with posttraumatic coxarthrosis. The findings were compared to those of the controls. RESULTS: Changes in ENMG findings for fibular nerve in 49 patients with dysplastic coxarthrosis were bilateral and showed significant difference only from the norm. In 19 of 66 cases (27.9%) low M-responses (р 0.02) were found in the side subject to THR. In 87.3% of cases, the signs of a decrease in the conductivity of proximal segments of the tibial nerve were revealed. In patients with posttraumatic coxarthrosis, the significant decrease in ENMG findings from both fibular and tibial nerves was observed in the affected side, they made up just 42-50% of those in the opposite side. Asymptomatic progress of denervation damage in hip and tibia muscles sometimes required needle EMG to fund the signs of motor innervation disorder. A-waves revealed in 65% of patients suggested local damage to one or both portions of SN. CONCLUSION: ENMG findings in patients with dysplastic arthrosis of the hip enabled revealing of the signs of neuropathy before surgeries and decreasing the risk of neurologic post-surgery complications.

scholarly journals ESTUDIO ANATÓMICO EN FETOS HUMANOS: DIVISIÓN DEL NERVIO CIÁTICO Y SU RELACIÓN CON LA TÉCNICA ANESTÉSICA DE WINNIE A NIVEL GLÚTEO. ANATOMICAL STUDY IN HUMAN FETUSES: SCIATIC NERVE DIVISION RELATED TO WINNIE´S ANAESTHETIC APPROACH AT GLUTEAL LEVEL

2016 ◽  
Vol 2 (1) ◽  
pp. 25-30
Author(s):  
Evangelina Espósito ◽  
Sebastián A, Parisi ◽  
Matías F. Sosa ◽  
Alberto I. Herrando ◽  
Susana N. Biasutto
Keyword(s):  
Sciatic Nerve ◽  
Anatomical Study ◽  
Popliteal Fossa ◽  
Lower Limbs ◽  
Posterior Region ◽  
Gluteal Region ◽  
Formaldehyde Solution ◽  
Human Fetuses ◽  
Lower Side ◽  
Sacral Plexus

Introducción: El nervio ciático nace por la unión de todas las raíces del plexo sacro, sale de la pelvis por la parte inferior de la incisura isquiática mayor, desciende siguiendo la línea media en la región posterior del muslo y se divide en nervios tibial y peroneo, generalmente, a nivel del ángulo superior de la fosa poplítea. No obstante, es posible que se divida en cualquier punto de su recorrido, por lo que los bloqueos anestésicos que se realizan en la región glútea podrían ser insuficientes. Objetivo: Investigar el origen de los nervios tibial y peroneo, sus variantes en el trayecto hacia la región poplítea y su relación con la efectividad de la anestesia mediante el abordaje de Winnie. Material y Método: Se disecaron 50 fetos humanos (88 extremidades inferiores), fijados por inmersión en solución de formol, de entre 10 y 26 semanas de gestación y ambos géneros. Resultados: El nervio ciático se divide en nervios tibial y peroneo del siguiente modo: a) dentro de la fosa poplítea, en el 73,9% de los casos, b)  en la región del muslo posterior, en el 11,4% de los casos, c) en la región glútea, en el 4,5% de los casos, y d) nunca se constituye el nervio ciático, en el 10,2%. Conclusión: El bloqueo anestésico puede ver reducida su eficacia cuando se utiliza el abordaje glúteo como ocurre en la Técnica de Winnie, dado que se podría bloquear solamente uno de los troncos del nervio ciático.Introduction: The sciatic nerve originates by the junction of the sacral plexus roots, leaves the pelvis through the lower side of the greater ischiatic foramen, continues downwards along the medial line of the posterior region of the thigh and divides into tibial and peroneal nerves usually at the upper angle of the popliteal fossa. But that division may happen in upper levels and cause an incomplete anesthetic block in gluteal region. Our objective was to determine the origin of the tibial and peroneal nerves, its variations and the relation with the effectiveness in the anesthetic block by Winnie’s approach. Material and Method: We dissected 50 human fetuses (88 lower limbs), between 10 to 26 weeks of gestation, of both genders and fixed by immersion in formaldehyde solution. Results: The sciatic nerve divides into tibial and peroneal nerves in the following way: a) inside the popliteal fossa, 73.9% of the cases, b) in the posterior region of the thigh, 11.4% of the cases, c) in the gluteal region, 4.5% of the cases, and d) those cases in which there is not a sciatic nerve, in the 10.2%. Conclusion: The anesthetic block may reduce its effectiveness in gluteal approach, as it happens in Winnie’s approach, if only one of the sciatic nerve branches is involved.

Simultaneous end-to-side coaptations of two severed nerves to a single healthy nerve in rats

2006 ◽  
Vol 4 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Serhat Özbek ◽  
M. Ayberk Kurt
Keyword(s):  
Experimental Study ◽  
Nerve Regeneration ◽  
Rat Model ◽  
Axonal Regeneration ◽  
Sural Nerve ◽  
Tibial Nerve ◽  
Distal Stump ◽  
The Common ◽  
Fibular Nerve ◽  
Common Fibular Nerve

Object This experimental study was designed to evaluate functional and sensory outcomes and morphological features observed after simultaneous end-to-side coaptations of distal stumps of two nerves to a single neighboring nerve. Studies were performed using both parallel and end-to-side coaptation (PEC) and serial end-to-side coaptation (SEC) methods in a rat model. Methods In the PEC group, distal stumps of the sural and common fibular nerves were coapted to the intact tibial nerve 1 cm apart from each other in an end-to-side fashion. In the SEC group, identical surgical procedures apart from the coaptation method were conducted. For the coaptation method in this group, the distal stump of the common fibular nerve was first coapted to the side of the intact tibial nerve, and then the distal stump of the sural nerve was coapted to the side of the common fibular nerve 1 cm apart from the first coaptation site. Nonoperated contralateral sides were used as controls. Nerve regeneration in both groups was evaluated functionally, electrophysiologically, and histomorphometrically. Conclusions When there is a need for two end-to-side coaptations of two severed nerves, PEC is the recommended method of choice to obtain better axonal regeneration into both nerves.

scholarly journals Anatomical study on sciatic nerve variations in Andhra Pradesh, India

2019 ◽  
Vol 7 (8) ◽  
pp. 3085
Author(s):  
K. Lakshmi Kumari ◽  
M. Sushma ◽  
A. Raja ◽  
D. Asha Latha
Keyword(s):  
Sciatic Nerve ◽  
Anatomical Study ◽  
Anatomical Variations ◽  
Ischial Tuberosity ◽  
Popliteal Fossa ◽  
The Body ◽  
Lower Limbs ◽  
Gluteal Region ◽  
Pelvic Cavity ◽  
Human Cadavers

Background: The sciatic nerve is the largest and widest nerve in the body and is derived from ventral rami of spinal nerves L2 to S3. Sciatic nerve appears in the Gluteal region below Piriformis from Pelvic cavity by passing through Greater Sciatic foramen. In between the Ischial tuberosity and greater trochanter of Femur, it reaches the back of the thigh. At the superior angle of Popliteal fossa, it divides into Tibial and common Peroneal (fibular) nerves. The division varies, and it may occur within the pelvis, Gluteal, upper, mid and lower part of thigh. The anatomical variations of the level at which the Sciatic nerve divides is considered important by Neurosurgeons, Anaesthetists, Orthopaedicians and Surgeons.Methods: This study was conducted on 52 lower limbs to determine the level of sciatic nerve bifurcation and its variations on 26 embalmed human cadavers. The data was analyzed manually using numbers, frequencies and percentages.Results: The findings of this study states that in 2 limbs (3.84%) the nerve divided in the gluteal region; in 4 limbs (7.69%) in the pelvic region; in 10 limbs (19.23%) at the junction between upper and middle thigh. The highest incidence of division occurs in 36 limbs (69.23%) at the superior angle of the popliteal fossa.Conclusions: The findings of this study revealed that the majority of sciatic nerve divisions occur   at the superior angle of popliteal fossa while some divided into other regions such as Pelvis, Gluteal and thigh regions.

scholarly journals The level of the sciatic nerve division and its relations to the piriform muscle

2005 ◽  
Vol 62 (1) ◽  
pp. 45-49 ◽  
Author(s):  
Sladjana Ugrenovic ◽  
Ivan Jovanovic ◽  
Vladislav Krstic ◽  
Vesna Stojanovic ◽  
Ljiljana Vasovic ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Lower Extremities ◽  
Common Peroneal Nerve ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Sacral Plexus ◽  
The Common ◽  
Popliteal Block

Background. The sciatic nerve, as the terminal branch of the sacral plexus, leaves the pelvis through the greater sciatic foramen beneath the piriform muscle. Afterwards, it separates into the tibial and the common peroneal nerve, most frequently at the level of the upper angle of the popliteal fossa. Higher level of the sciatic nerve division is a relatively frequent phenomenom and it may be the cause of an incomplete block of the sciatic nerve during the popliteal block anesthesia. There is a possibility of different anatomic relations between the sciatic nerve or its terminal branches and the piriform muscle (piriformis syndrome). The aim of this research was to investigate the level of the sciatic nerve division and its relations to the piriform muscle. It was performed on 100 human fetuses (200 lower extremities) which were in various gestational periods and of various sex, using microdissection method. Characteristic cases were photographed. Results. Sciatic nerve separated into the tibial and common peroneal nerve in popliteal fossa in 72.5% of the cases (bilaterally in the 66% of the cases). In the remainder of the cases the sciatic nerve division was high (27.5% of the cases) in the posteror femoral or in the gluteal region. Sciatic nerve left the pelvis through the infrapiriform foramen in 192 lower extremities (96% of the cases), while in 8 lower extremities (4% of the cases) the variable relations between sciatic nerve and piriform muscle were detected. The common peroneal nerve penetrated the piriform muscle and left the pelvis in 5 lower extremities (2.5% of the cases) and the tibial nerve in those cases left the pelvis through the infrapiriform foramen. In 3 lower extremities (1.5% of the cases) common peroneal nerve left the pelvis through suprapiriform, and the tibial nerve through the infrapiriform foramen. The high terminal division of sciatic nerve (detected in 1/3 of the cases), must be kept in mind during the performing of popliteal block anesthesia. Conclusion. Although very rare, anatomical abnormalities of common peroneal nerve in regard to piriform muscle are still possible.

scholarly journals Cadaveric Study of the Mode of Termination of the Sciatic Nerve in a Malian Population: Cases of Trifurcation and Hexafurcation

2021 ◽  
Author(s):  
Tata Touré ◽  
Babou Ba ◽  
Adoul Kader Moussa ◽  
Abdoulaye Kanté ◽  
Falé Traoré ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peroneal Nerve ◽  
Tibial Nerve ◽  
Artery Aneurysm ◽  
Common Peroneal Nerve ◽  
Anatomical Variations ◽  
Popliteal Fossa ◽  
Terminal Branch ◽  
Cross Sectional ◽  
Significant Difference

Abstract Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.

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