Chirurgie de la névralgie pudendale par voie transglutéale

The surgical treatment of pudendal neuralgia is considered when conservative treatments, such as neuropathic pain medication, pudendal nerve infiltration, and physical therapy, fail. The indication for surgery depends on at least one positive result of pudendal block. The trangluteal approach makes it possible to see all the conflicting areas visible at the subpiriform canal, pince ligamentaire — between the sacrotuberal ligament and sacrospinatus ligament — and pudendal canal. It allows the release and transposition of the nerve, restoring its freedom and mobility. This surgical procedure is safe and significantly improves the condition of two-thirds of patients. Age is an important prognostic factor. A randomized study has validated the surgical release of the pudendal nerve by transgluteal approach; it is the only treatment method that has been validated for this disorder. Performing the procedure in knee-chest position and the neurotomy of the obturator internus muscle nerve are two technical advancements that can improve outcome.     

Revisión de las parálisis braquiales neonatales observadas en el Hospital Sant Joan de Déu de Barcelona

ObjectiveTo evaluate the maternal, neonatal and delivery risk factors that could be associated with brachial plexus palsy in the neonate.Material and methodWe performed a retrospective study of maternal and neonatal medical records between January 1988 and May 1999.ResultsAmong 27 287 deliveries, there were 23 cases of brachial plexus palsy. A total of 65.2% of the patients delivering a newborn with a brachial plexus lesion were overweight before pregnancy and presented excessive weight gain during pregnancy. Four mothers were diabetic. Forceps delivery and vacuum extraction were associated in 73.9% of newborns with brachial palsy and previous shoulder dystocia was observed in three of these. The mean birth weight was 4073.34 g, and 56.5% of newborns weighed more than 4000 g. Notably, 60.8% of the children with brachial palsy made a complete recovery.ConclusionsThe factors associated with brachial palsy are weight more than 4000 g, forceps or vacuum delivery, excessive weight gain, diabetes, and shoulder dystocia.