lumbosacral plexus surgery

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Post on 01-Jun-2015



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


  • 1. LumbosacralPlexus SurgeryHector Giocoli, MDBuenos Aires - Argentina

2. Characteristics Low incidence: Rarely reported lesions, witch, ifposttraumatic, may remain undiagnosed because ofthe variable destination of the patients in emergency Difficult level diagnosis: Patients witch differentparenchimal or visceral lesions, with differentproblems witch hinder motility (And frequentlyaffected 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 3. EtiologyTraumatic Events Herniorrhaphy Obstetrical trauma Appendectomy Hysterectomy Surgery Lumbar sympatectomy Lateral approach to the Abdominal surgery spine Gynecological procedures Tumors Intrapelvic Terminal branches 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 5. AnatomyLumbar Plexus SubservedMuscle are: Abdominal Psoas Iliac Pectineus Sartorius Quadriceps femoris Adductors of the thigh 6. AnatomySacral Plexus Spinal roots L5, S1,and L2 (L4) Lies on the sacro iliacjunction Medial to psoas musclebetween it and the column Hypogastric arteryintermigles the nerve trunksand asending veins coverthe plexus The lumbosacral trunk isgiven by components fromL4 and from L5 7. AnatomySacral PlexusSubserved Muscle are: Glutei Obturator Piriform Gemelli Quadratus Muscle or posterior thigh Anterior tibial Peroneal foot abductorsand extensors Triceps surae and plantarflexors 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 9. Surgical TechniquesIntraoperative electrophysiological recording 10. Surgical Approach 11. Surgical Approach 12. Surgical Approach 13. Surgical Approach NeurolysisSciatic 14. Surgical Approach 15. Surgical Approach 16. Intrabdominal 17. Surgical Approach 18. Surgical ApproachPsoas NeurolysisFemoral 19. Results30 days later 20. Results3 months later 21. Posterior ApproachSacrectomy Nerve grafting 22. Surgical Approach Sciatic NerveClassic Technique Our 23. Surgical Approach Sciatic NerveNeurolysisAesthetic results 24. Surgical Approach Sciatic Nerve 25. Surgical ApproachSciatic 26. Pelvis TumorTumorIncision 27. Pelvis TumorTumorExtirpation 28. Pelvis Tumor 29. Anterior Approach Total extirpationFemoral 30. Posterior ApproachSciatic nerve 31. Pelvis Tumor Total 32. Results5 months 33. Femoral 34. Femoral 35. Femoral 36. Distal and Proximal StumpCommon Peroneal Nerve 37. Common Peroneal NerveResultsGrafts 38. Tibial Nerve Palsy 39. Tibial Nerve 40. Tibial Nerve PalsyResultsNerve Grafting 41. Posterior Tibial Nerve 42. Posterior Tibial NerveNeurolysis 43. Posterior Tibial Nerve 44. Posterior Tibial Nerve 45. Results After 29 patientsMale Female Good Fear 46. Tha nky o u !!


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