A step towards stereotactic navigation during pelvic surgery: 3D nerve topography

Area of Science:

• Medical Imaging
• Surgical Navigation
• Neuroanatomy

Background:

• Rectal cancer treatment can cause long-term morbidity due to nerve injury.
• Stereotactic navigation in rectal surgery requires precise anatomical visualization.
• Identifying pelvic nerves at risk is crucial for minimizing iatrogenic damage.

Purpose of the Study:

• To investigate the feasibility of creating a 3D map of pelvic nerves using magnetic resonance imaging (MRI).
• To assess the ability to identify and delineate pelvic nerves on MRI for surgical planning.

Main Methods:

• A systematic review identified positional references for pelvic nerves.
• High-resolution 3-Tesla MRI scans were performed on 20 volunteers.
• Nerves were manually delineated, and their identifiability and correctness were evaluated.

Main Results:

• Sacral nerves, lumbosacral plexus, and obturator nerves were identified in all volunteers.
• Sympathetic trunks, hypogastric plexuses/nerves, and pudendal nerves showed high identification rates.
• Levator ani nerves were difficult to identify, but other delineated nerves were confirmed with 100% accuracy.

Conclusions:

• High-resolution MRI with dedicated protocols can visualize pelvic nerves.
• Accurate 3D mapping of pelvic nerves is achievable.
• Integrating this knowledge into stereotactic navigation can reduce nerve injury and improve patient outcomes.