Lecture Notes - Pelvic Neurovasculature

Lecture Notes - Pelvic Neurovasculature

The streaming video of the 2004-5 lab overview is available on the web (password protected).
The computer presentation used by Ms. Stein in lecture is available on the web (password protected). You can also download the PowerPoint presentation to print or review.

Vessels

Common Iliacs

External Iliacs - vessel of lower limb
Internal Iliacs - pelvis, gluteals, medial thigh, perineum

Internal Iliac - highly variable!!

posterior division - parietal branches only

iliolumbar
lateral sacral
superior gluteal

anterior division - parietal and visceral branches

inferior gluteal
obturator (30% aberrant)
internal pudendal (around sacrospinous ligament)
umbilical (1st branch off anterior division)
superior vesical (artery of the ductus deferens)
middle rectal
inferior vesical (prostatic branches)
uterine (relationship to ureter!!)
vaginal

Innervation

Sacral Plexus

ventral primary rami of L4,5 (aka, lumbosacral trunk) and S1,2,3,4
relationship to piriformis muscle

Autonomics

Inferior hypogastric plexus (sides of rectum) - continuation of preaortic plexus via hypogastric nerves
Sacral splanchnics - sympathetic fibers from sacral portion of sympathetic chain
Pelvic splanchnics - parasympathetic fibers from S2,3,4

Review Intro to Autonomics Module - this is the time to make it all come together!
Also, review the formation of the inferior hypogastric plexus (Pelvic Autonomics Module)

where do sympathetics come from?
where do parasympathetics come from?
how are specific pelvic viscera innervated?
Pelvic Diaphragm/Floor

Wall of Pelvic Cavity

Obturator Internus m.

Arcus Tendineus Levator Ani - attachment for portion of levator ani m.

Piriformis m. - exits pelvis via greater sciatic foramen, sacral plexus lays on piriformis

Floor or Diaphragm

Above = pelvic cavity
Below = perineum

Coccygeus m. - on internal surface of sacrospinous ligament
Levator Ani m.

pubococcygeus
iliococcygeus
puborectalis
genital hiatus