Lumbosacral plexus surgery
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Lumbosacral plexus surgery



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

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



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    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
    • EtiologyTraumatic Events • Herniorrhaphy Obstetrical trauma • Appendectomy • Hysterectomy Surgery • Lumbar sympatectomy • Lateral approach to the  Abdominal surgery spine  Gynecological procedures Tumors  Intrapelvic  Terminal branches
    • 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
    • Anatomy Lumbar Plexus Subserved Muscle are:  Abdominal  Psoas  Iliac  Pectineus  Sartorius  Quadriceps femoris  Adductors of the thigh
    • 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
    • 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
    • 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
    • Surgical TechniquesIntraoperative electrophysiological recording
    • Surgical Approach
    • Surgical Approach
    • Surgical Approach
    • Surgical Approach NeurolysisSciatic nerve
    • Surgical Approach
    • Surgical Approach
    • Intrabdominal Graft
    • Surgical Approach
    • Surgical Approach Psoas NeurolysisFemoral nerve
    • Results30 days later
    • Results3 months later
    • Posterior ApproachSacrectomy Nerve grafting
    • Surgical Approach Sciatic NerveClassic Technique Our Approach
    • Surgical Approach Sciatic Nerve NeurolysisAesthetic results
    • Surgical Approach Sciatic Nerve Tumor
    • Surgical ApproachSciatic Nerve Follow-up
    • Pelvis Tumor TumorIncision
    • Pelvis Tumor TumorExtirpation
    • Pelvis Tumor Tumor
    • Anterior Approach Total extirpationFemoral nerve
    • Posterior ApproachSciatic nerve Tumor
    • Pelvis Tumor Total extirpation
    • Results5 months later
    • Femoral Surgery
    • Femoral Surgery
    • Femoral Surgery
    • Distal and Proximal Stump Common Peroneal Nerve
    • Common Peroneal Nerve Results Grafts
    • Tibial Nerve Palsy Incision
    • Tibial Nerve Palsy Neuroma
    • Tibial Nerve Palsy ResultsNerve Grafting
    • Posterior Tibial Nerve
    • Posterior Tibial Nerve Neurolysis
    • Posterior Tibial Nerve
    • Posterior Tibial Nerve Stumps Grafts
    • Results After 29 patientsMale Female Good Fear Bad
    • Tha nky o u !!