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Pudendal Afferents Mapping in Posterior Sacral Rhizotomies

Ogiwara, Hideki MD, PhD; Morota, Nobuhito MD

doi: 10.1227/NEU.0000000000000235
Research-Human-Clinical Studies

BACKGROUND: The effectiveness of pudendal afferents mapping in posterior sacral rhizotomies needs to be reviewed.

OBJECTIVE: To evaluate the effectiveness of pudendal afferents mapping for both the dorsal penile or clitoral nerve and the inferior anal nerve to decrease the risk of postoperative bowel and bladder dysfunction when the sacral nerve roots are candidates for rhizotomies.

METHODS: A retrospective review of 101 Asian children who underwent functional posterior rhizotomies with pudendal afferents mapping for spastic paresis was performed.

RESULTS: Pudendal mapping was successful in 75 of 81 patients. The highest activity of afferent fibers of the dorsal penile or clitoral nerve was demonstrated at the S1 roots in 13.3%, at the S2 in 79.3%, and at the S3-5 in 7.3%. Considerable activity of the dorsal penile or clitoral nerve was recorded at 40% of the S1 roots, at 99.3% of the S2 roots, and at 52% of the S3-5 roots. The highest activity of afferent fibers of the inferior anal nerve was demonstrated at S2 roots in 42% and at S3-5 roots in 58%. Considerable activity of the inferior anal nerve was recorded at 10.7% of S1 roots, at 89.3% of S2 roots, and at 76.7% of S3-5 roots. The pathological S1 roots were divided into 3 to 4 rootlets, and the rootlets with significant afferent activity were preserved. None of the 75 patients experienced long-term bowel or bladder complications.

CONCLUSION: Pudendal afferent mapping identified the sacral rootlets involved with genital and anal sensation. The preservation of such rootlets in sacral rhizotomies is considered to be important for minimizing postoperative bladder and bowel dysfunction.

ABBREVIATION: DRAP, dorsal root action potential

Author Information

Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan

Correspondence: Hideki Ogiwara, MD, PhD, Okura 2-10-1, Setagaya-ku, Tokyo, 157-8535, Japan. E-mail:

Received June 10, 2013

Accepted October 18, 2013

Copyright © by the Congress of Neurological Surgeons