Possover Marc
Department for Surgical Gynecology and Neuropelveology Hirslanden Clinic, Zürich, Switzerland.
Surg Technol Int. 2010 Apr;19:123-8.
Neurophysiological investigations and neurosurgical procedures of the sacral plexus are not especially well developed, because the sacral plexus is difficult to access. Awareness that sacral radiculopathies may exist is still lacking and the incidence of these pathologies is widely underestimated. Since the recent introduction of laparoscopy in the field of pelvic nerves, the situation has changed considerably: laparoscopy not only permits a precise morphological and functional exploration of the entire sacral plexus, but also offers new therapeutic options: In lesions to the sacral nerve roots by compression, infiltration, or surgical damages, the laparoscopy offers an adequate access for micro-neurosurgical procedures; whereas in neurogenic pathologies or situations of failure of neurosurgical treatments, the technique of laparoscopic implantation of a neuroprosthesis - the LION procedure - permits the neuromodulation of all sacral nerve roots in different combination with only one electrode for simultaneous control of pelvic/lower limb pain and pelvic visceral dysfunctions. Regarding the dramatically increased incidence of sacral radiculopathies, especially secondary to pelvic prolaps surgeries by blind mesh-material implantation, this field of pathologies has to come in the focus of medical interests. Also, physicians involved in pelvic pathologies/surgeries have to be trained in clinical neuropelveology.
骶丛的神经生理学研究和神经外科手术发展得并不特别完善，因为骶丛难以触及。目前人们对可能存在的骶神经根病仍缺乏认识，这些病症的发病率也被广泛低估。自从腹腔镜技术最近引入盆腔神经领域以来，情况发生了很大变化：腹腔镜不仅能对整个骶丛进行精确的形态学和功能探索，还提供了新的治疗选择：对于因压迫、浸润或手术损伤导致的骶神经根病变，腹腔镜为显微神经外科手术提供了足够的入路；而在神经源性病症或神经外科治疗失败的情况下，腹腔镜植入神经假体的技术——LION手术——允许通过仅一个电极以不同组合对所有骶神经根进行神经调节，从而同时控制盆腔/下肢疼痛和盆腔内脏功能障碍。鉴于骶神经根病的发病率急剧上升，尤其是继发于盲目植入网状材料的盆腔脱垂手术，这一病症领域必须成为医学关注的焦点。此外，参与盆腔病症/手术的医生必须接受临床神经盆腔学的培训。
