Lumbosacral plexus surgery
Upcoming SlideShare
Loading in...5
×
 

Lumbosacral plexus surgery

on

  • 880 views

Dr. Héctor Giócoli's own methods and results for lumbosacral plexus surgery

Dr. Héctor Giócoli's own methods and results for lumbosacral plexus surgery

Statistics

Views

Total Views
880
Views on SlideShare
879
Embed Views
1

Actions

Likes
0
Downloads
48
Comments
0

1 Embed 1

http://www.slashdocs.com 1

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Lumbosacral plexus surgery Lumbosacral plexus surgery Presentation Transcript

    • LumbosacralPlexus Surgery Hector Giocoli, MD Buenos Aires - Argentina
    • Characteristics Low incidence: Rarely reported lesions, witch, if posttraumatic, may remain undiagnosed because of the variable destination of the patients in emergency Difficult level diagnosis: Patients witch different parenchimal or visceral lesions, with different problems witch hinder motility (And frequently affected by severe pain) Difficult surgical treatment:  Analogous lesions in the brachial plexus are normally treated, and results are quite well known.  In this anatomical district surgical approach is not so comfortable and familiar www.hgiocoli.com
    • EtiologyTraumatic Events • Herniorrhaphy Obstetrical trauma • Appendectomy • Hysterectomy Surgery • Lumbar sympatectomy • Lateral approach to the  Abdominal surgery spine  Gynecological procedures Tumors  Intrapelvic  Terminal branches www.hgiocoli.com
    • Anatomy Lumbar Plexus  Spinal roots L2, L3, and L4 (L1 and L5)  Located in the corner between vertebral bodies and lateral apophisis  Covered by  Ascending iliac and cava veins, and by psoas muscle  By aorta and common iliac arteries on the right side  By iliac arterial and venous plexuses on the leftwww.hgiocoli.com
    • Anatomy Lumbar Plexus Subserved Muscle are:  Abdominal  Psoas  Iliac  Pectineus  Sartorius  Quadriceps femoris  Adductors of the thigh www.hgiocoli.com
    • Anatomy Sacral Plexus  Spinal roots L5, S1, and L2 (L4)  Lies on the sacro iliac junction  Medial to psoas muscle between it and the column  Hypogastric artery intermigles the nerve trunks and asending veins cover the plexus  The lumbosacral trunk is given by components from L4 and from L5 www.hgiocoli.com
    • Anatomy Sacral Plexus Subserved Muscle are:  Glutei  Obturator  Piriform  Gemelli  Quadratus  Muscle or posterior thigh  Anterior tibial  Peroneal foot abductors and extensors  Triceps surae and plantar flexors www.hgiocoli.com
    • Surgical Techniques  Anterior: extraperitoneal  Lateral: extraperitoneal  Anterior: transperitoneal  Posterior: sacrectomyIn some cases is impossible to access to themore proximal sciatic nerve, the bony andligamentous rim of the greater sciatic notch canbe nibbled or drilled away to gain access www.hgiocoli.com
    • Surgical TechniquesIntraoperative electrophysiological recording www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Surgical Approach NeurolysisSciatic nerve www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Intrabdominal Graft www.hgiocoli.com
    • Surgical Approach www.hgiocoli.com
    • Surgical Approach Psoas NeurolysisFemoral nerve www.hgiocoli.com
    • Results30 days later www.hgiocoli.com
    • Results3 months later www.hgiocoli.com
    • Posterior ApproachSacrectomy Nerve grafting www.hgiocoli.com
    • Surgical Approach Sciatic NerveClassic Technique Our Approach www.hgiocoli.com
    • Surgical Approach Sciatic Nerve NeurolysisAesthetic results www.hgiocoli.com
    • Surgical Approach Sciatic Nerve Tumor www.hgiocoli.com
    • Surgical ApproachSciatic Nerve Follow-up www.hgiocoli.com
    • Pelvis Tumor TumorIncision www.hgiocoli.com
    • Pelvis Tumor TumorExtirpation www.hgiocoli.com
    • Pelvis Tumor Tumor www.hgiocoli.com
    • Anterior Approach Total extirpationFemoral nerve www.hgiocoli.com
    • Posterior ApproachSciatic nerve Tumor www.hgiocoli.com
    • Pelvis Tumor Total extirpation www.hgiocoli.com
    • Results5 months later www.hgiocoli.com
    • Femoral Surgery www.hgiocoli.com
    • Femoral Surgery www.hgiocoli.com
    • Femoral Surgery www.hgiocoli.com
    • Distal and Proximal Stump Common Peroneal Nerve www.hgiocoli.com
    • Common Peroneal Nerve Results Grafts www.hgiocoli.com
    • Tibial Nerve Palsy Incision www.hgiocoli.com
    • Tibial Nerve Palsy Neuroma www.hgiocoli.com
    • Tibial Nerve Palsy ResultsNerve Grafting www.hgiocoli.com
    • Posterior Tibial Nerve www.hgiocoli.com
    • Posterior Tibial Nerve Neurolysis www.hgiocoli.com
    • Posterior Tibial Nerve www.hgiocoli.com
    • Posterior Tibial Nerve Stumps Grafts www.hgiocoli.com
    • Results After 29 patientsMale Female Good Fear Bad www.hgiocoli.com
    • Tha nky o u !!www.hgiocoli.com