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Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.

Publication ,  Journal Article
Patil, PG; Friedman, AH
Published in: Neurosurgery
January 2005

OBJECTIVE: To increase awareness among neurosurgeons of alternative surgical approaches to lesions of the sciatic nerve in the gluteal region. METHODS: The dominant surgical approach to lesions of the proximal sciatic nerve involves detachment and medial reflection of the gluteus maximus through a question-mark incision. An alternative to this infragluteal exposure is a transgluteal approach, which provides access to the sciatic nerve by splitting the gluteus maximus through a curvilinear incision. We explored the anatomy and surgical history of these approaches through cadaveric study, our own case series, and a literature review. RESULTS: The infragluteal approach uses a larger incision, extensive dissection, and postoperative bracing while allowing wide exposure of the nerve inferiorly into the thigh. By contrast, the transgluteal approach minimizes dissection and spares muscle attachments but requires meticulous attention to hemostasis and provides a more focal exposure of the sciatic nerve. During the past century, the infragluteal approach has been described more frequently and has become increasingly popular among peripheral-nerve surgeons. For comparison, we present three patients in whom the transgluteal approach was used to treat substantial lesions of the proximal sciatic nerve. CONCLUSION: At the present time, the majority of peripheral nerve surgeons use an infragluteal approach to the proximal sciatic nerve. However, for select patients with well-defined and localized lesions, the transgluteal approach may provide sufficient nerve exposure with lowered operative complexity and postoperative morbidity.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

January 2005

Volume

56

Issue

1 Suppl

Start / End Page

165 / 171

Location

United States

Related Subject Headings

  • Sciatic Neuropathy
  • Sciatic Nerve
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Muscle, Skeletal
  • Middle Aged
  • Humans
  • Female
  • Buttocks
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
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Patil, P. G., & Friedman, A. H. (2005). Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches. Neurosurgery, 56(1 Suppl), 165–171. https://doi.org/10.1227/01.neu.0000144169.84261.9d
Patil, Parag G., and Allan H. Friedman. “Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.Neurosurgery 56, no. 1 Suppl (January 2005): 165–71. https://doi.org/10.1227/01.neu.0000144169.84261.9d.
Patil, Parag G., and Allan H. Friedman. “Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.Neurosurgery, vol. 56, no. 1 Suppl, Jan. 2005, pp. 165–71. Pubmed, doi:10.1227/01.neu.0000144169.84261.9d.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

January 2005

Volume

56

Issue

1 Suppl

Start / End Page

165 / 171

Location

United States

Related Subject Headings

  • Sciatic Neuropathy
  • Sciatic Nerve
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Muscle, Skeletal
  • Middle Aged
  • Humans
  • Female
  • Buttocks
  • Adult