Site of Deafferentation and Electrode Placement for Bladder Stimulation: Clinical Implications

Hohenfellner, Markus; Paick, Jae‐Seung; Trigo-Rocha, Flavio; Schmidt, Richard A.; Kaula, Norbert; Thüroff, Joachim W.; Tanagho, Emil A.

doi:10.1016/s0022-5347(17)37674-7

Cited by 34 publications

(15 citation statements)

References 16 publications

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“…Throughout the course from their originating point to their exit from the dura, the rootlets maintain their identity as separate bundles that can be dissected under magnification. These results are in accordance with those found by Hohenfellner et al (1992). This made it possible for microelectrode techniques to stimulate groups of neurons and axons innervating the bladder detrusor in the sacral spinal cord, without simultaneous excitement of the EUS.…”

Section: Discussionsupporting

confidence: 91%

Microsurgical Anatomy of Lumbosacral Nerve Rootlets for Highly Selective Rhizotomy in Chronic Spinal Cord Injury

Zhou

Wang

Huang

et al. 2010

The Anatomical Record

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It is known that selective sacral roots rhizotomy is effective for relieving the neurogenic bladder associated with spinal cord injury. The goal of this study is to review the surgical anatomy of the lumbosacral nerve rootlets and to provide some morphological bases for highly selective sacral roots rhizotomy. Spinal cord dissections were performed on five cadavers under surgical microscope. At each spinal cord segment, we recorded the number, diameter and length of the rootlets, subbundles and bundles from the L1 to S2 spinal segments, and the length of the dorsal/ventral root entry zone. Peripheral nervous system myelin was examined by immunohistochemistry. We found: (1) the ventral or the dorsal root of the lumbosacral segment of the spinal cord was divided into one to three nerve bundles and each bundle was subdivided into one to three subbundles. Each subbundle further gave out two to three rootlets connected with the spinal cord; (2) there were no significant differences in the number of rootlets within the L1 to S2 segments, but the size of rootlets and the length of nerve roots varied (P < 0.05); and (3) the more myelinated fibers a rootlet contained, the larger transection area it had. The area of peripheral nervous system myelin positive cells and the total area of rootlets were correlated (P < 0.001). Thus, during highly selective sacral roots rhizotomy, the ventral and dorsal roots can be divided into several bundles of rootlets, and we could initially distinct the rootlets by their diameters. Anat Rec, 293:2123Rec, 293: -2128Rec, 293: , 2010. V V C 2010 Wiley-Liss, Inc.Key words: microsurgical anatomy; lumbosacral nerve rootlet; highly selective sacral rootlets rhizotomy; spinal cord injuryInjuries to the central nervous system in humans are associated with a low degree of neurological recovery and, in most cases, lifelong debilitation. Spinal cord injury (SCI) can result not only in paraplegia or quadriplegia but also in loss of urinary and defecatory control as well as alteration of sexual function (Pedersen, 1983;

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Section: Discussionsupporting

confidence: 91%

Microsurgical Anatomy of Lumbosacral Nerve Rootlets for Highly Selective Rhizotomy in Chronic Spinal Cord Injury

Zhou

Wang

Huang

et al. 2010

The Anatomical Record

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“…Previous studies showed that the sacral root emerged from the ation and, if successful, will represent a significant advance in achieving bladder control. The findings of spinal cord in several rootlets [12], prompting our attempt to stimulate the rootlets. The preliminary success this study will be implemented in current clinical trials to improve the selectivity and responsiveness of sacral in obtaining more selective responses by stimulating individual rootlets than by stimulating the total sacral root implants.…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation of the ventral sacral roots after de-afferentation, in most cases, induces bladation holds true for the dorsal root also). In a previous study [12] we advocated intradural de-afferentation of der contraction and bladder evacuation.…”

Section: Introductionmentioning

confidence: 99%

Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?

Probst

Piechota

Hohenfellner

et al. 1997

British Journal of Urology

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Objective To determine by anatomical and functional studies whether stimulation of sacral rootlets might permit selective stimulation of autonomic fibres, thus avoiding the detrusor/sphincter dyssynergia characteristic of current techniques of neurostimulation for bladder evacuation. Materials and methods In 10 male mongrel dogs, the S2 root was isolated and its constituent rootlets followed from their origin in the spinal cord to the point of exit from the dura. The entire root and the individual rootlets were then stimulated, including intra‐ and extra‐dural stimulation and at proximal, mid and distal levels. Results Neuroanatomical and histological findings showed that the rootlets of ventral S2 maintain their identity throughout their intradural course; some carry predominantly autonomic fibres, some predominantly somatic and some a mixture of the two. Conclusion It appears surgically feasible to identify, isolate and sever the predominantly somatic rootlets intradurally, sparing the predominantly autonomic rootlets for inclusion in extradural electrode placement around the entire sacral root, thus eliminating sphincteric interference with detrusor contraction for voiding at low pressure.

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“…Pudendal nerve anastomoses are carried out to innervate a functioning neosphincter in patients having undergone a rectal excision (Sato et al, 1997). Electrodes may be placed on the pudendal nerve (or its root or branches) to treat anal or urethral sphincter insufficiency (Hohenfellner et al, 1992).…”

Section: Introductionmentioning

confidence: 99%

The course and branching pattern of pudendal nerve in fetus

et al. 2008

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The pudendal nerve is a considerably large branch of the sacral plexus. There are many articles in the literature concerning the pudendal nerve in adults, but as far as we know, there is none on the branching pattern and variations in pudendal nerve anatomy in fetus. This study investigates the pudendal nerve trunking with respect to the piriformis muscle in 25 formalin-fixed fetuses (50 sides of pelves, 15 females, 10 males), ranging from 20 to 37 weeks of gestation. We investigate pudendal nerve trunking in four types: Type I-a is defined as single-trunk with the inferior rectal nerve branching proximal to the dorsal nerve of penis/clitoris (38%), Type I-b is also single-trunk with the dorsal nerve of penis/clitoris branching proximal to the inferior rectal nerve (24%), Type II is double-trunk with medial trunk as an inferior rectal nerve (34%), and Type III is triple-trunk (4%). We measured the average diameter of the main trunk of pudendal nerve in Type I-a and I-b groups to be 0.98 +/- 0.33 mm. We also measured the average length of the pudendal nerve trunks before the dorsal nerve of penis/clitoris branch to be 7.35 +/- 3.50 mm. There was no significant statistical difference in the average length, diameter, number of trunks, and pudendal nerve variations between male and female and also right and left sides of the pelves. This first and detailed fetal study of pudendal nerve trunking with respect to the piriformis muscle would be useful for educational anatomy dissections and anatomical landmark definitions for relevant clinical procedures.

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Site of Deafferentation and Electrode Placement for Bladder Stimulation: Clinical Implications

Cited by 34 publications

References 16 publications

Microsurgical Anatomy of Lumbosacral Nerve Rootlets for Highly Selective Rhizotomy in Chronic Spinal Cord Injury

Microsurgical Anatomy of Lumbosacral Nerve Rootlets for Highly Selective Rhizotomy in Chronic Spinal Cord Injury

Neurostimulation for bladder evacuation: is sacral root stimulation a substitute for microstimulation?

The course and branching pattern of pudendal nerve in fetus

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