Diagnosis and management of pudendal nerve entrapment syndromes: Impact of MR neurography and open MR-guided injections

Nerve entrapment syndromes involving the pudendal nerve have been challenging for the neurologist and neurosurgeon relative to other nerve entrapment syndromes because of the nature of the presenting symptoms and the technically demanding aspects of specific diagnosis. Further, effective treatment options have been few. Recently however, there have been a series of advances in diagnosis and treatment. Application of magnetic resonance neurography imaging and the use of open magnetic resonance guided injection techniques have greatly improved diagnostic efficacy. New minimal access surgical techniques targeted at various subtypes of pudendal entrapment-greater sciatic notch, ischial spine, obturator internus/Alcock canal, and distal branch have resulted in 87% good to excellent treatment outcomes in a prospective study of 55 patients.