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ULTRASOUND ARTICLES
Three-Dimensional/Four-Dimensional Volumetric Ultrasound Imaging of the Sciatic Nerve
  1. Manoj Karmakar, MD*,
  2. Xiang Li, PhD†,
  3. Jiawei Li, MPhil*,
  4. Xavier Sala-Blanch, MD‡,
  5. Admir Hadzic, MD§ and
  6. Tony Gin, MD*
  1. From the *Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR;
  2. †Department of Emergency Medicine, Minhang Hospital of Shanghai, Minhang, Shanghai, People’s Republic of China;
  3. ‡Department of Anesthesia, Hospital Clinic, University of Barcelona, Barcelona, Spain; and
  4. §Department of Anaesthesiology, College of Physicians and Surgeons, Columbia University, St. Luke’s and Roosevelt Hospitals, New York, NY.
  1. Address correspondence to: Manoj K. Karmakar, MD, FRCA, FHKCA, FHKAM, Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, SAR, People’s Republic of China (e-mail: karmakar{at}cuhk.edu.hk).

Abstract

Introduction Currently, there are limited data on the use of 3-dimensional ultrasound to image peripheral nerves. We undertook this imaging study to determine the feasibility of using 3-dimensional ultrasound imaging to delineate the anatomy of the sciatic nerve.

Methods After research ethics committee approval and written informed consent, 4 healthy young adult male volunteers underwent 3-dimensional ultrasound scan of the sciatic nerve. A Voluson 730 Expert (GE Healthcare, Austria) with a broadband convex volume transducer (4–8.5 MHz) was used to scan the sciatic nerves at 3 levels: the subgluteal space, posterior aspect of the midthigh, and at the apex of the popliteal fossa. Three-dimensional volumetric ultrasound scan of the sciatic nerve was performed with the transverse plane as the data acquisition plane. The acquired 3-dimensional volumes were also rendered using a 3-dimensional volume-rendering software and displayed as a multiplanar image or as a “niche” display.

Results The right sciatic nerve was successfully scanned using the broadband convex volume transducer in all 4 volunteers. A distinct perineural space was identified around the sciatic nerve from the subgluteal space to the level of the popliteal fossa. Proximally, the sciatic nerve was visualized in a hypoechoic “subgluteal space” between the epimysium of the gluteus maximus and the quadratus femoris muscle. More distally, a hypoechoic “perineural” space was identifiable between the sciatic nerve and the hamstrings muscles. The niche view demonstrated the cranial extension of the subgluteal space, as an intermuscular tunnel or as a conduit for the sciatic nerve.

Conclusions We have demonstrated that it is feasible to perform 3-dimensional ultrasound imaging of the sciatic nerve. The anatomic information obtained is more detailed than that with a 2-dimensional scan, which provides better insight into the spatial relationship of the sciatic nerve with its surrounding structures. A distinct “perineural space” was also identified alongside the course of the sciatic nerve, which may play a significant role in sciatic nerve blockade.

https://doi.org/10.1097/AAP.0b013e318232eb92

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    Footnotes

    • The authors have no conflict of interest to declare.

    • This work was locally funded by the Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, People’s Republic of China.