Extended anterolateral transiliac approach to the sacral plexus.

Area of Science:

• Surgical Anatomy
• Orthopedic Surgery

Background:

• The sciatic plexus and lateral sacrum are anatomically challenging surgical targets.
• Limited surgical approaches exist for accessing these deep pelvic structures.

Purpose of the Study:

• To describe and evaluate a transiliac anterolateral surgical approach for accessing the sciatic plexus and lateral sacrum.
• To assess the feasibility and outcomes of this approach for tumor resection and plexus release.

Main Methods:

• A subperitoneal anterolateral approach was extended by sectioning the iliac bone.
• This transiliac technique allows exposure of the lumbosacral trunk, sacral foramina, and sciatic plexus.
• Exposure could be further extended via lumbotomy, ischiorectal fossa opening, or trochanterotomy.

Main Results:

• The approach was utilized in 18 cases, including 13 malignant tumor resections and 5 plexus releases.
• Surgical objectives were consistently met.
• Procedure duration ranged from 3-6 hours with blood loss of 500-4,000ml.
• One septic complication occurred, which resolved after debridement.

Conclusions:

• The transiliac anterolateral approach offers a viable method for surgical access to the sciatic plexus and lateral sacrum.
• This technique is effective for complex oncologic resections and plexus decompression procedures.
• The approach allows for systematic exposure and can be augmented with adjacent surgical techniques.