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Sacral neuromodulation: sacral anatomy and optimal lead placement.

Whitney K Hendrickson1, Cindy L Amundsen2

  • 1Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, 5324 McFarland Drive, Unit 310, Durham, NC, 27707, USA. whendric09@gmail.com.

International Urogynecology Journal
|November 25, 2020
PubMed
Summary

This video guides optimal sacral neuromodulation (SNM) lead placement using cadaveric anatomy and fluoroscopy. Understanding S3 foramen landmarks ensures efficient and successful SNM procedures.

Keywords:
Fecal incontinenceOptimal lead placementOveractive bladderSacral neuromodulationSacral neurostimulationUrgency incontinenceUrinary retention

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Area of Science:

  • Anatomy
  • Surgical Procedures
  • Medical Education

Background:

  • Sacral neuromodulation (SNM) is a treatment for lower urinary tract dysfunction.
  • Optimal lead placement is crucial for SNM efficacy.
  • Accurate anatomical understanding aids procedural success.

Purpose of the Study:

  • To create an instructional video correlating cadaveric anatomy with fluoroscopic images.
  • To enhance conceptualization of optimal foramen needle and lead placement for SNM.
  • To improve the efficiency and success rate of SNM procedures.

Main Methods:

  • A sacral neuromodulation (SNM) procedure was performed and recorded on a fresh female cadaver.
  • Fluoroscopic images were obtained to illustrate bony relationships to the S3 foramen and nerve.
  • Cadaveric dissection highlighted the S3 nerve tract and techniques for optimal needle placement.

Main Results:

  • The video effectively demonstrates the correlation between cadaveric anatomy and fluoroscopic views.
  • Key bony landmarks for S3 foramen identification were highlighted.
  • Techniques for achieving optimal foramen needle placement were showcased.

Conclusions:

  • Optimal foramen needle placement within the S3 foramen is critical for successful SNM lead placement.
  • Understanding fluoroscopic bony landmarks in relation to cadaveric S3 nerve anatomy is essential.
  • Optimized placement can lead to reduced OR time, enhanced programming, and lower amplitude requirements.