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

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  • 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 familiarwww.hgiocoli.com 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. 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. AnatomyLumbar Plexus SubservedMuscle are: Abdominal Psoas Iliac Pectineus Sartorius Quadriceps femoris Adductors of the thigh www.hgiocoli.com 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 www.hgiocoli.com 7. AnatomySacral PlexusSubserved Muscle are: Glutei Obturator Piriform Gemelli Quadratus Muscle or posterior thigh Anterior tibial Peroneal foot abductorsand extensors Triceps surae and plantarflexors www.hgiocoli.com 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 accesswww.hgiocoli.com 9. Surgical TechniquesIntraoperative electrophysiological recording www.hgiocoli.com 10. Surgical Approach www.hgiocoli.com 11. Surgical Approach www.hgiocoli.com 12. Surgical Approach www.hgiocoli.com 13. Surgical Approach NeurolysisSciatic nervewww.hgiocoli.com 14. Surgical Approach www.hgiocoli.com 15. Surgical Approach www.hgiocoli.com 16. Intrabdominal Graftwww.hgiocoli.com 17. Surgical Approach www.hgiocoli.com 18. Surgical ApproachPsoas NeurolysisFemoral nervewww.hgiocoli.com 19. Results30 days later www.hgiocoli.com 20. Results3 months later www.hgiocoli.com 21. Posterior ApproachSacrectomy Nerve grafting www.hgiocoli.com 22. Surgical Approach Sciatic NerveClassic Technique Our Approachwww.hgiocoli.com 23. Surgical Approach Sciatic NerveNeurolysisAesthetic results www.hgiocoli.com 24. Surgical Approach Sciatic Nerve Tumorwww.hgiocoli.com 25. Surgical ApproachSciatic NerveFollow-upwww.hgiocoli.com 26. Pelvis TumorTumorIncision www.hgiocoli.com 27. Pelvis TumorTumorExtirpation www.hgiocoli.com 28. Pelvis Tumor Tumorwww.hgiocoli.com 29. Anterior Approach Total extirpationFemoral nervewww.hgiocoli.com 30. Posterior ApproachSciatic nerve Tumorwww.hgiocoli.com 31. Pelvis Tumor Total extirpationwww.hgiocoli.com 32. Results5 months laterwww.hgiocoli.com 33. Femoral Surgerywww.hgiocoli.com 34. Femoral Surgerywww.hgiocoli.com 35. Femoral Surgerywww.hgiocoli.com 36. Distal and Proximal StumpCommon Peroneal Nerve www.hgiocoli.com 37. Common Peroneal NerveResultsGrafts www.hgiocoli.com 38. Tibial Nerve Palsy Incisionwww.hgiocoli.com 39. Tibial Nerve PalsyNeuromawww.hgiocoli.com 40. Tibial Nerve PalsyResultsNerve Grafting www.hgiocoli.com 41. Posterior Tibial Nerve www.hgiocoli.com 42. Posterior Tibial NerveNeurolysis www.hgiocoli.com 43. Posterior Tibial Nerve www.hgiocoli.com 44. Posterior Tibial Nerve StumpsGraftswww.hgiocoli.com 45. Results After 29 patientsMale Female Good Fear Badwww.hgiocoli.com 46. Tha nky o u !!www.hgiocoli.com

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