Hi Carol, how did the neurologists visit go ?
James.


--- james weber <redjay25@...> wrote:
>
> Hi Carol, I went for piriformis release surgery on
> April 5th, at least that was the plan. After I came
> round in the post op area the surgeon came to see me
> and explained that he did not perform the piriformis
> release surgery as planned. He asked me before I was
> wheeled in to surgery where I had felt the most pain
> during my 3 years of pain. This is where he started
> the surgery. The following is a medical transciption
> of what was done in the operating room.
>
> Under general anesthesia in the prone position the
> right leg, hip and buttock were prepped and draped
> in
> the usual fashion. A zigzag incision was then
> fashioned over the posterior thigh extending into
> the
> gluteal crease extending laterally. Skin and
> subcutaneous tissue was carefully elevated to avoid
> any significant nerve branches. There was one
> perforator coming off the posterior fascia which was
> cauterised and divided. Next, the fascia overlying
> the
> gluteas maximus was incised and extended down in the
> midline between the hamstring muscles. Very careful
> dissection was then carried down layer by layer
> until
> we identified the sciatic nerve and a retractor was
> carefully placed between the hamstring muscle groups
> to allow for adequate exposure.
> It was immediately apparent in the region of his
> maximum pain that there were two vascular leashes
> which could be resulting in his pathology. One was
> between the two hamstring groups and clearly
> compressing the nerve. After meticulous dissection
> this was freed from the sciatic nerve, and the
> vessels
> clipped and divided. There was an area of underlying
> colour change within the sciatic nerve. We then
> dissected posteriorly down into the posterior thigh
> releasing fascia and any thickened areas of the
> investing subcutaneous tissue. Once we were
> thoroughly
> happy that the distal component of the nerve was
> decompressed we extended proximally. We lifted up
> the
> caudal end of the gluteas maximus and again bluntly
> dissected up along the nerve. There were no areas of
> significant fascia and clearly the piriformis muscle
> was not significantly compressing the nerve as we
> were
> able to pass a finger right into the pelvis through
> the foramina.
> We did however find another vessel which was
> transversing right between a hamstring branch in the
> main body of the nerve which was a potential source
> of
> compression. We again dissected this vascular leash
> from componenets of the nerve, clipped it and
> divided
> it. With these completed there were no signs of any
> embarrassment of the sciatic nerve along its course.
> Copious irrigation was used and we ensured we had
> meticulius hemostasis. A marcaine block was then
> placed on the nerve, and the wound was closed. 3-0
> Vicryl was used in the subcutaneous tissue and a 4-0
> Monocryl in the skin. Steri Strips were applied, as
> was the dressing. Anesthesia was reversed and the
> patient was extubated and transferred to the
> recovery
> room in satisfactory condition.
>
> Carol, you might want to print this off and discuss
> it
> with the surgeon during your visit.
> I am happy with the results and making a good
> recovery.
> James.
>
>
>
>
> --- Carol <lakriskonfekt@...> wrote:
> > Hello everyone,
> >
> > I finally had the visit with the surgeon regarding
> > piriformis
> > surgery -- and what a visit!! He agreed he would
> do
> > the surgery
> > anytime I want to do it. Though I'm don't think
> he
> > is the person to
> > do it. If found out he has practiced medicine for
> > many years and is
> > well respected. He has only preformed 8-10
> surgeries
> > of this kind.
> > His thought was to remove the piriformis muscle.
> > This would result
> > in learning to use the other muscle to walk. I
> > would have to use a
> > walker for the first 4 weeks and then have a
> > recovery of 3-6 months.
> > I would not know if it would have worked until
> > around 6 months. I
> > personally believe this was a little over the top.
>
> > Since if this
> > does not work the botox would no longer help since
> > the muscle is
> > gone!! I did ask if he knew of any other doctor
> who
> > has done this
> > kind of surgery. He could only come up with one
> > doctor in Maryland.
> >
> > I don't know if I make any sense I really confused
> > regarding my next
> > step. I have an appointment with my pain doctor,
> as
> > well, as my
> > neurologist in 2 weeks and will run everything by
> > them. Since my
> > neurologist is part of a different group he might
> > know of someone
> > else to recommend.
> >
> > I would appreciate any feedback.
> >
> > Thanks,
> >
> >
> >
>
>
>
>
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