TY  - JOUR
T1  - Variant anatomy of sciatic nerve and their clinical implications
TT  - Siyatik sinirin varyasyon anatomisi ve klinik yansımaları
AU  - Aktan İkiz, Z. Aslı
AU  - Bilge, Okan
AU  - Üçerler, Hülya
AU  - Çelik, Servet
AU  - Boduç, Erengül
PY  - 2018
DA  - June
DO  - 10.19161/etd.414980
JF  - Ege Tıp Dergisi
JO  - EJM
PB  - Ege University
WT  - DergiPark
SN  - 1016-9113
SP  - 88
EP  - 93
VL  - 57
IS  - 2
LA  - en
AB  - Aim: Theaim of present study was to demonstrate the variations of piriformis muscle,sciatic nerve and its branches and discuss their clinical importance.Materials and Methods: Fifty-two gluteal and lower limb regions of 26 formalin fixed malecadavers were evaluated in Ege University Faculty of Medicine, Department of Anatomy.The anatomical relationship between the sciatic nerve and the piriformismuscle, and division level of sciatic nerve in thigh was recorded.Results: Thesciatic nerve exited the pelvis as a single branch through the infrapiriformforamen with no variation in 84.62% of the lower limbs. The division variationsof sciatic nerve were determined in 23.08%. In 8 of 12 high divisions wereobserved in gluteal regions (15.38%). The common peroneal nerve and the tibialnerve entered deep gluteal region via the greater sciatic foramen belowpiriformis muscle separately in four lower limbs (7.69%). Two separate nervedivisions passed above and through (or below) the piriformis muscle and thencombined together to form common peroneal nerve while tibial nerve passingbelow the piriformis muscle in 4 lower limbs (7.69%). In 2 of 12, high divisionoccurred in the 1/3 upper portion of the thigh unilaterally (3.85%). The divisionof sciatic nerve in the popliteal fossa was seen in two lower limbs (3.85%).Conclusion: The clinical importance of the sciatic nerve around the piriformismuscle or in the thigh was discussed for piriformis syndrome, palsy after totalhip arthroplasty, intramuscular injections in gluteal region and failedpopliteal nerve block.
KW  - Sciatic nerve
KW  - piriformis syndrome
KW  - palsy
KW  - hip replacement
KW  - anatomical variations.
N2  - Amaç: Çalışmanın amacı musculuspiriformis, siyatik sinir ve dallarının varyasyonlarını göstermek ve klinikönemini tartışmaktır.Gereç ve Yöntem: Ege Üniversitesi Tıp Fakültesi, Anatomi Anabilim Dalı’nda formalin ilefikse edilmiş 26 erkek kadavraya ait 52 adet gluteal bölge ve alt ekstremitedeğerlendirildi. Siyatik sinir ve musculus piriformis arasındaki anatomikilişki ile uylukta siyatik sinirin dallanma seviyesi kaydedildi.Bulgular: Alt ekstremitelerin %84.62’sinde siyatik sinir pelvisten tek dalhalinde, varyasyonsuz olarak çıktı. Siyatik sinirin dallanma varyasyonu %23.08olarak tespit edildi. On iki adet olarak bulunan yüksekten ayrılmanın 8’igluteal bölgede idi (%15.38). Dört alt ekstremitede (%7.69) nervus peroneuscommunis ve nervus tibialis derin gluteal bölgeye foramen ischiadicum majusyolu ile musculus piriformis’in altından ayrı ayrı girdi. Dört alt ekstremitedeise (%7.69) iki ayrı dal musculus piriformis’in üzerinden, içinden (ya daaltından) geçti ve nervus tibialis musculus piriformis’in altından geçerken buiki dal da nervus peroneus communis’i oluşturmak üzere daha sonra birleşti. Oniki örneğin ikisinde, yüksekte ayrılma unilateral olarak uyluğun 1/3 üstbölümünde izlendi. Siyatik sinirin fossa poplitea’da dallarına ayrılması da ikialt ekstremitede görüldü (%3.85).Sonuç: Siyatik sinirin musculus piriformis çevresindeki veya uyluktaki varyasyonları;piriformis sendromu, total kalça protezi sonrası ortaya çıkan paralizi, glutealbölgeye uygulanan intramusküler enjeksiyonlar ve başarısız popliteal sinirbloğu yönü ile tartışıldı.
CR  - Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J. Anatomical variations between the sciatic nerve and the piriformis muscle a contribution to surgical anatomy in piriformis syndrome. Surg Radiol Anat 2014;36(3):273-80.
CR  - Cassidy L, Walters A, Bubb K, Shoja MM, Tubbs RS, Loukas M. Piriformis syndrome: Implications of anatomical variations, diagnostic techniques, and treatment options. Surg Radiol Anat 2012;34(6):479-86.
CR  - Kanawati AJ. Variations of the sciatic nerve anatomy and blood supply in the gluteal region: A review of the literature. ANZ J Surg 2014;84(11):816-9.
CR  - Pokorny D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat 2006;28(1):88-91.
CR  - Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: A review. Clin Anat 2010;23(1):8-17.
CR  - Adibatti M, V S. Study on variant anatomy of sciatic nerve. J Clin Diagn Res 2014;8(8):AC07-9.
CR  - Grgić V. Piriformis muscle syndrome: Etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis and therapy. Lijec Vjesn 2013;135(1-2):33-40.
CR  - Güvençer M, Iyem C, Akyer P, Tetik S, Naderi S. Variations in the high division of the sciatic nerve and relationship between the sciatic nerve and the piriformis. Turk Neurosurg 2009;19(2):139-44.
CR  - Prakash, Bhardwaj AK, Devi MN, Sridevi NS, Rao PK, Singh G. Sciatic nerve division: A cadaver study in the Indian population and review of the literature. Singapore Med J 2010;51(9):721-3.
CR  - Coelho P, Melo C, Bernardes A. Rare anatomical variation of absence of the sciatic nerve: Completely substituted by the tibial and common fibular nerve. Acta Med Port 2013;26(3):283-6.
CR  - Battaglia PJ, Scali F, Enix DE. Co-presentation of unilateral femoral and bilateral sciatic nerve variants in one cadaver: A case report with clinical implications. Chiropr Man Therap 2012;20(1):34.
CR  - Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: A systematic review. Eur Spine J 2010;19(12):2095-109.
CR  - Delabie A, Peltier J, Havet E, Page C, Foulon P, Le Gars D. Relationships between piriformis muscle and sciatic nerve: radioanatomical study with 104 buttocks. Morphologie 2013;97(316):12-8.
CR  - Gomes BA, Ramos MR, Fiorelli RK, Almeida CR, Fiorelli SK. Topographic anatomical study of the sciatic nerve relationship to the posterior portal in hip arthroscopy. Rev Col Bras Cir 2014;41(6):440-4.
CR  - Vloka JD, Hadzić A, April E, Thys DM. The division of the sciatic nerve in the popliteal fossa: Anatomical implications for popliteal nerve blockade. Anesth Analg 2001;92(1):215-7.
CR  - Saleh HA, El-fark MM, Abdel-Hamid GA. Anatomical variation of sciatic nerve division in the popliteal fossa and its implication in popliteal nerve blockade. Folia Morphol (Warsz) 2009;68(4):256-9.
CR  - Chiang EP, Dangerfield P, Asay D, Cucchiaro A, Berger JS. Ultrasound imaging of the sciatic nerve division in the popliteal fossa: a volunteer study. Open J Anesthesiol 2013;3(5):288-292.
CR  - Beaton LE, Anson BJ. The relation of the sciatic nerve and of its subdivisions to the piriformis muscle. Anat Rec 1937;70(1):1-5.
CR  - Beaton LE, Anson BJ. The sciatic nerve and the piriformis muscle: Their interrelation a possible cause of coccygodynia. J Bone Joint Surg 1938;20(3):686-8.
CR  - Pais D, Casal D, Bettencourt Pires MA, Furtado A, et al. Sciatic nerve high division: two different anatomical variants. Acta Med Port 2013;26(3):208-11.
CR  - Broadhurst NA, Simmons DN, Bond MJ. Piriformis syndrome: Correlation of muscle morphology with symptoms and signs. Arch Phys Med Rehabil 2004;85(12):2036-39.
CR  - Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve 2009;40(1):10-18.
CR  - Moore KL, Dalley AF. Clinically Oriented Anatomy. Fourth Edition. London: Lippincott, Williams & Wilkins; 1999:560.
CR  - Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: Description of a new technique. J Arthroplasty 2006;21(7):1038-46.
CR  - Sosna A, Pokorny D, Jahoda D. Sciatic nerve palsy after total hip replacement. J Bone Joint Surg 2005;87(8):1140-1.
UR  - https://doi.org/10.19161/etd.414980
L1  - https://dergipark.org.tr/en/download/article-file/457263
ER  -