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Lower Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
The sacral plexus is a collection of spinal nerves responsible for the innervation of the skin and muscles of the pelvis and leg. It is located anterior to the piriformis muscle on the surface of the posterior pelvic wall.
Blocks of Nerves of the Sacral Plexus Supplying the Lower Extremities
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The sacral plexus is formed by the union of the ventral rami from L5, S1, S2, S3, and partly from L4 and S4 spinal nerves.11 L4 and L5 ventral rami unite closely at their emergence from intervertebral foramina, thus constituting the lumbosacral trunk which appears at the medial border of the psoas major muscle (Figure 2.28). The lumbosacral trunk runs over the pelvic brim, towards the sacro-iliac joint where it unites with the ventral ramus of the first sacral nerve (Figure 2.1B). The other sacral rami join the plexus just above the greater sciatic notch, thus constituting (1) a lower small band, plexiform in arrangement and prolonged into the pudendal nerve; and (2) an upper large band prolonged by the sciatic nerve, which passes out of the pelvis at this level.
Clinical Features of Colorectal Adenoma and Adenocarcinoma
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Jamie Murphy, Norman S. Williams
Radial spread from a cancer situated on the posterior wall of the rectum may extend through the mesorectum to the fascia of Waldeyer. The latter may act as a deterrent to further spread, but invasion through it is not uncommon. In such cases, the sacral plexus, sacrum or coccyx may become involved. Anterior spread from a tumour situated below the peritoneal reflection in the male may result in invasion of Denonvillier’s fascia to the prostate, seminal vesicles and bladder. In the female, such spread will first penetrate the cervix uteri and posterior vaginal wall, unless the patient has had a hysterectomy, when anterior infiltration may involve the bladder.
Clinical effect of computed guided pudendal nerve block for patients with premature ejaculation: a pilot study
Published in Scandinavian Journal of Urology, 2020
Fouad Aoun, Georges Mjaess, Joseph Assaf, Anthony Kallas Chemaly, Tonine Younan, Simone Albisinni, Fabienne Absil, Thierry Roumeguère, Renaud Bollens
Anatomically, the pudendal nerve is a branch of the sacral plexus [19–21]. It emerges from the S2, S3 and S4 roots, then departs the pelvis from the greater sciatic foramen along with the sciatic roots, between the sacrospinal and the sacrotuberous ligament, and re-enters the pelvis via the lesser sciatic foramen [19–21]. At this level, it releases a superior hemorroidal branch and then cruises through a duplication of the obturator muscle’s fascia called ‘Alcock’s canal’. The pudendal nerve gives rise at the exit of Alcock’s canal to three main branches which are the inferior rectal branch, the perineal branch and the dorsal sensory nerve of the penis or clitoris [19–21]. The pudendal nerve entrapment consists of a compression of this nerve especially between sacrospinous and sacrotuberous ligaments (which constitutes the most common level of entrapment) or in Alcock’s canal [19–21].
MRI-guided definition of cerebrospinal fluid distribution around cranial and sacral nerves: implications for brain tumors and craniospinal irradiation
Published in Acta Oncologica, 2019
Amber M. Wood, Maarten H. Lequin, Marielle M. Philippens, Enrica Seravalli, Sabine L. Plasschaert, Marry M. van den Heuvel-Eibrink, Geert O. Janssens
Healthy, adult volunteers underwent an MRI (Philips, 1.5 Tesla) scan of the skull-base and sacral plexus within the radiotherapy department of the University Medical Center Utrecht. The scans were generated in supine position on a soft Philips yellow MRI long mattress with knee support, with the neck in neutral position. For the imaging of the brain and sacral plexus a Philips dStream Headspine coil and a dStream WholeBody (posterior) coil were used, respectively. To evaluate the extension of the CSF, coronally acquired 3 D T2-weighted TSE images with fat suppression, high signal to noise ratio and little to no motion-related artifacts were used. On these images, CSF is rendered white and surrounding tissue gray.
Maintaining sexual function after pelvic floor surgery
Published in Climacteric, 2019
Innervation of the vagina arises from hypogastric and sacral plexus. These supply the sympathetic and parasympathetic nerve supply to the pelvic organs whereas the somatic sensory supply is from the pudendal nerve. The clitoris in innervated by the sympathetic (T1–L3) and parasympathetic (S2–S4) fibers with somatic sensory innervation arising from the dorsal nerve of the clitoris. Engorgement of the female genitalia is mediated through the autonomic nerve supply. These structures may be altered during pelvic floor surgery and one hypothesis of genital arousal disorders occurring postoperatively is autonomic denervation of the female erectile tissue.