Abstract - Pelvic Neuralgias by Neuro-Vascular Entrapment

[nyt]

If you go to http://www.ncbi.nlm.nih.gov/pubmed/26606029 you can download the entire article for free.

Pain Physician. 2015 Nov;18(6):E1139-43.

Pelvic Neuralgias by Neuro-Vascular Entrapment: Anatomical Findings in a Series of 97 Consecutive Patients Treated by Laparoscopic Nerve Decompression.

Possover M1, Forman A2.

Abstract
BACKGROUND:
Some patients have pelvic, pudendal, or low lumbar pain radiating into the legs that is worse while sitting but differs from pudendal neuralgia. The purpose of this study was to present a new clinical entity of neuropathic pelvic pain by pelvic neuro-vascular entrapment.
OBJECTIVES:
To report about the locations of predilection for pelvic neurovascular entrapment.
STUDY DESIGN:
Prospective cohort pre- and post-intervention.
SETTING:
University referral unit specializing in advanced gynecological surgery and neuropelveology.
METHODS:
Patients, Intervention: In a prospective study, 97 patients presenting with intractable pelvic neuropathic pain (pudendal pain, gluteal pain, vulvodynia, coccygodynia, and sciatic pain) underwent laparoscopic exploration with decompression of compressed pelvic somatic nerves. The population included 76 (78.3%) women and 21 men. Indication for laparoscopic exploration of pelvic nerves suspected to be involved in pain has been indicated after neuropelveological work up, pelvic neuro-magnetic resonance imaging (MRI) and Doppler-sonography. Pain evolution was recorded over 2 years after the procedure.
MEASUREMENTS AND MAIN RESULTS:
Three entities were isolated: pudendal neuralgie by compression at the less sciatic notch, sacral radiculopathy at S2-4 by compression at the infracardinal level of the sacral plexus, and sciatica L5-S1/2 by compression at the greater sciatic notch. Pain was worse sitting (98%), during menstrual bleeding in women, and during Valsalva maneuver, but the pain did not wake the patients up at night and was not accompanied by neurologic dysfunctions. A decrease in VAS scores (> 50%) at 2 years follow-up was observed in 86 patients (88.6%).
CONCLUSIONS:
Neuro-vascular entrapment is a pathophysiologic phenomenon implicated in several pelvic neuropathies. The most common are L5-S1 sciatica, pudendal neuralgia, and sacral radiculopathy. After intraoperative confirmation, laparoscopic exploration of the entire sacral plexus is essential to diagnose conflict. Laparoscopic decompression is a treatment of choice, based on the separation of the offending vessel from the nerves. Those procedures are safe, with a high success rate; the neuropelveological approach is essential in order to obtain good treatment results. The laparoscopic approach gives the possibility of reducing morbidity and improving results by providing wider insight into the operating field with smaller intraoperative injury.
KEY WORDS:
Vulvodynia, coccygodynia, chronic pelvic pain, pudendal pain, neuro-vascular conflict.

[wannagetbetter]

Has anyone here been treated by Possover? Has anyone had this type of surgery and was it successful? How is it diagnosed?

[nyt]

In the search on the top right put in "Possover" you might find someone who has been treated by him.

About 5-6 years ago I contacted him via email because Dr. Howard suggested he might be a physician who could do the stimulator surgery he thought would be helpful. Dr. Possover did respond to my email. I spoke with one woman about the time I contacted him whom met him at a conference when he was here in the states and he evaluated her while he was here. I do not know if he would still do that. She decided not to have surgery with him because there was no one here in the states that could do the follow-up care if she had any problems.

Dr. Possover practiced initially in Germany before he moved and I have a friend in Germany who is an MD told me Dr. Possover had a great reputation.