Lumbosacral plexus surgery

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

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Lumbosacral plexus surgery

  1. 1. LumbosacralPlexus Surgery Hector Giocoli, MD Buenos Aires - Argentina
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. Anatomy Lumbar Plexus Subserved Muscle are:  Abdominal  Psoas  Iliac  Pectineus  Sartorius  Quadriceps femoris  Adductors of the thigh www.hgiocoli.com
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. Surgical TechniquesIntraoperative electrophysiological recording www.hgiocoli.com
  10. 10. Surgical Approach www.hgiocoli.com
  11. 11. Surgical Approach www.hgiocoli.com
  12. 12. Surgical Approach www.hgiocoli.com
  13. 13. Surgical Approach NeurolysisSciatic nerve www.hgiocoli.com
  14. 14. Surgical Approach www.hgiocoli.com
  15. 15. Surgical Approach www.hgiocoli.com
  16. 16. Intrabdominal Graft www.hgiocoli.com
  17. 17. Surgical Approach www.hgiocoli.com
  18. 18. Surgical Approach Psoas NeurolysisFemoral nerve www.hgiocoli.com
  19. 19. Results30 days later www.hgiocoli.com
  20. 20. Results3 months later www.hgiocoli.com
  21. 21. Posterior ApproachSacrectomy Nerve grafting www.hgiocoli.com
  22. 22. Surgical Approach Sciatic NerveClassic Technique Our Approach www.hgiocoli.com
  23. 23. Surgical Approach Sciatic Nerve NeurolysisAesthetic results www.hgiocoli.com
  24. 24. Surgical Approach Sciatic Nerve Tumor www.hgiocoli.com
  25. 25. Surgical ApproachSciatic Nerve Follow-up www.hgiocoli.com
  26. 26. Pelvis Tumor TumorIncision www.hgiocoli.com
  27. 27. Pelvis Tumor TumorExtirpation www.hgiocoli.com
  28. 28. Pelvis Tumor Tumor www.hgiocoli.com
  29. 29. Anterior Approach Total extirpationFemoral nerve www.hgiocoli.com
  30. 30. Posterior ApproachSciatic nerve Tumor www.hgiocoli.com
  31. 31. Pelvis Tumor Total extirpation www.hgiocoli.com
  32. 32. Results5 months later www.hgiocoli.com
  33. 33. Femoral Surgery www.hgiocoli.com
  34. 34. Femoral Surgery www.hgiocoli.com
  35. 35. Femoral Surgery www.hgiocoli.com
  36. 36. Distal and Proximal Stump Common Peroneal Nerve www.hgiocoli.com
  37. 37. Common Peroneal Nerve Results Grafts www.hgiocoli.com
  38. 38. Tibial Nerve Palsy Incision www.hgiocoli.com
  39. 39. Tibial Nerve Palsy Neuroma www.hgiocoli.com
  40. 40. Tibial Nerve Palsy ResultsNerve Grafting www.hgiocoli.com
  41. 41. Posterior Tibial Nerve www.hgiocoli.com
  42. 42. Posterior Tibial Nerve Neurolysis www.hgiocoli.com
  43. 43. Posterior Tibial Nerve www.hgiocoli.com
  44. 44. Posterior Tibial Nerve Stumps Grafts www.hgiocoli.com
  45. 45. Results After 29 patientsMale Female Good Fear Bad www.hgiocoli.com
  46. 46. Tha nky o u !!www.hgiocoli.com

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