Abstract
Neuropathic perineal pains are generally linked to suffering of the pudendal nerve. But some patients present pains described as a type of burning sensation located more laterally on the anal margin and on areas including the scrotum or the labiae majorae, the caudal and medial parts of the buttock and the upper part of the thigh. These pains extend beyond the territory of the pudendal nerve. It is interesting to note that the inferior cluneal nerves are responsible for the cutaneous sensitivity in the inferior part of the buttock. We wanted to check if these nerves, or some of their branches, could be responsible for such pains. An anatomic study, containing six dissections on corpse, has been conducted. The inferior cluneal nerves, emerging from the posterior femoral cutaneous nerve have some branches joining the perineum, especially by a perineal ramus. However, two conflict areas have been identified on the path of these nerves and on the perineal ramus: one at the level of the sacrotuberal ligament, and the other being the passage under the ischium. Two surgical approaches have been established from these observations with the aim of suppressing the conflicts.
Similar content being viewed by others
References
Beauthier JP, Lefevre P (1990) Traité d’anatomie, de la théorie à la pratique palpatoire, tome I: membre inférieur et ceinture pelvienne, éditions universitaires, pp 15, 45
Bensignor-Le Henaff M, Labat JJ, Robert T, Lajat Y (1993) Douleur périnéale et souffrance des nerfs honteux internes. Cah Anesthesiol 41:111–114
Bouchet A, Cuilleret J (1995) Anatomie topographique descriptive et fonctionnelle, tome 3b le membre inférieur, 3ème edn. Simep/Masson, p 1482
Bourgery (1867–1871) Traité complet de l’anatomie de l’Homme, tome 3 Appareil de la relation, névrologie, L Guérin, Paris, pp 290–291, 520. http://www.bium.univ-paris5.fr/histmed/medica/cote?02083x03
Kamina P (2002) Précis d’anatomie clinique tome I, 1re edn. Maloine, pp 506, 526, 527
Labat JJ, Robert R, Bensignor M, Buzelin JM (1990) Les névralgies du nerf pudendal (honteux interne). Considérations anatomo-cliniques et perspectives thérapeutiques. J Urol (Paris) 96:239–244
Labat JJ, Robert R, Guérineau M, Riant T (2005) Algies pelvi-périnéales chroniques: une approche globale. Rapport du XXVIIIe congrès de la SIFUD, pp 125–167
Netter FH (2003) Atlas d’anatomie humaine 3ème edn. Icon Learning System/Masson, pp 382, 469
Paturet G (1964) Traité d’anatomie humaine, tome IV: système nerveux, Masson, p 1032
Robert R, Labat JJ, Lehur PA et al (1989) Réflexions cliniques, neurophysiologiques et thérapeutiques à partir de données antomiques sur le nerf pudendal (honteux interne) lors de certaines algies périnéales. Chirurgie 115:515–520
Robert R, Brunet C, Faure A et al (1993) La chirurgie du nerf pudendal lors de certaines algies périnéales: évolution et résultats. Chirurgie 119:535–539
Robert R, Prat-Pradal D, Labat JJ et al (1998) Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat 20:93–98
Robert R, Bensignor M, Labat JJ et al (2004) Le neurochirurgien face aux algies périnéales: guide pratique. Neurochirurgie 50:533–539
Robert R, Labat JJ, Bensignor M et al (2005) Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation. Eur Urol 47:403–408
Rohen JW, Yokochi C, Lütjen drecoll E (1999) Anatomie humaine, atlas photographique d’anatomie systématique et topographique troisième édition, édition Maloine, pp 454–457
Rouvière H, Delmas A, Delmas V (2002) Anatomie humaine descriptive, topographique et fonctionnelle tome 3 Membres, 15ème edn. Masson, p 510
Williams PL, Warwick R, Dyson M, Bannister L (1989) Gray’s anatomy, 37th edn. Churchill Livingstone, London, pp 1145–1146. http://www.bartleby.com/107/213.html
Acknowledgments
The authors thank S. Lagier and Y. Blin for their technical collaboration.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Darnis, B., Robert, R., Labat, J.J. et al. Perineal pain and inferior cluneal nerves: anatomy and surgery. Surg Radiol Anat 30, 177–183 (2008). https://doi.org/10.1007/s00276-008-0306-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-008-0306-9