{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:03:02Z","timestamp":1787025782758,"version":"build-2736575974"},"reference-count":92,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2009,2]]},"abstract":"\n Object<\/jats:title>\n To improve diagnostic accuracy and achieve high levels of treatment success in patients with pudendal nerve entrapment (PNE) syndromes, the author of this study applied advanced technology diagnostics in distinguishing the various syndrome types according to the different entrapment locations and evaluated new minimal access surgical techniques to treat each subtype.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Two hundred cases were prospectively evaluated using a standardized set of patient-completed functional and symptom assessments, a collection of new physical examination maneuvers, MR neurography, open MR image\u2013guided injections, intraoperative neurophysiology, minimal access surgery, and formal outcome assessment with the Oswestry Disability Index, pain diagrams, and analog pain scales.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Four primary types of PNE syndromes were identified based on the different locations of entrapment: Type I, entrapment at the exit of the greater sciatic notch in concert with piriformis muscle spasm; Type II, entrapment at the level of the ischial spine, sacrotuberous ligament, and lesser sciatic notch entrance; Type III, entrapment in association with obturator internus muscle spasm at the entrance of the Alcock canal; and Type IV, distal entrapment of terminal branches. The application of new, targeted minimal access surgical techniques led to sustained good to excellent outcomes (50\u2013100% improvement in the pain score or functional score) in 87% of patients. Most of these patients obtained most of their improvement within 4 weeks of surgery, although some continued to experience progressive improvements up to 12 months after surgery.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The application of advanced diagnostics to categorize PNE syndrome origins into 4 major subtypes and the subsequent treatment of each subtype with a tailored strategy greatly improved therapeutic outcomes as compared with those reported when only a single treatment paradigm was applied to all patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/foc.2009.26.2.e9","type":"journal-article","created":{"date-parts":[[2009,3,26]],"date-time":"2009-03-26T10:39:23Z","timestamp":1238063963000},"page":"E9","source":"Crossref","is-referenced-by-count":126,"title":["Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery"],"prefix":"10.3171","volume":"26","author":[{"given":"Aaron G.","family":"Filler","sequence":"first","affiliation":[{"name":"Institute for Nerve Medicine, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0260009","series-title":"Pain Physician","first-page":"319","article-title":"A novel technique for pudendal nerve block","volume":"7","author":"Abdi","year":"2004"},{"key":"b2-0260009","series-title":"J Urol","first-page":"103","article-title":"Pudendal nerve terminal sensitive latency: technique and normal values","volume":"161","author":"Amarenco","year":"1999"},{"key":"b3-0260009","series-title":"Med Hypotheses","first-page":"349","article-title":"Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment","volume":"59","author":"Antolak","year":"2002"},{"key":"b4-0260009","series-title":"Dis Colon Rectum","first-page":"406","article-title":"Pudendal canal syndrome and proctalgia fugax: a mechanism creating pain","volume":"41","author":"Bascom","year":"1998"},{"key":"b5-0260009","series-title":"BMC Surg","first-page":"15","article-title":"Pudendal nerve decompression in perineology: a case series","volume":"4","author":"Beco","year":"2004"},{"key":"b6-0260009","series-title":"Am J Obstet Gynecol","first-page":"1663","article-title":"Pudendal neuralgia, a severe pain syndrome","volume":"192","author":"Benson","year":"2005"},{"key":"b7-0260009","series-title":"Reg Anesth Pain Med","first-page":"420","article-title":"Computed tomographyguided pudendal nerve block. A new diagnostic approach to long-term anoperineal pain: a report of two cases","volume":"25","author":"Calvillo","year":"2000"},{"key":"b8-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"431","article-title":"Magic angle effects in MR neurography","volume":"25","author":"Chappell","year":"2004"},{"key":"b9-0260009","series-title":"Int J Clin Pract","first-page":"553","article-title":"C-arm-guided pudendal nerve block: a new technique","volume":"60","author":"Choi","year":"2006"},{"key":"b10-0260009","series-title":"J Urol Medicale Chir","first-page":"98","article-title":"[Treatment of pelvic pain by the enervation by gluteal route of the pudendal nerve.]","volume":"61","author":"Darget","year":"1955"},{"key":"b11-0260009","series-title":"Neurosurg Q","first-page":"1","article-title":"Diagnosis and management of pudendal nerve entrapment syndromes: impact of MR neurography and open MR-guided injections","volume":"18","author":"Filler","year":"2008"},{"key":"b12-0260009","series-title":"Neurosurgery","article-title":"MR Neurography and Diffusion Tensor Imaging: Origins, history & clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5,000 patient study group","author":"Filler"},{"key":"b13-0260009","series-title":"J Neurosurg Spine","first-page":"99","article-title":"Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment","volume":"2","author":"Filler","year":"2005"},{"key":"b14-0260009","series-title":"Youmans' Neurological Surgery","article-title":"Piriformis syndrome, obturator internus syndrome, pudendal nerve entrapment and other pelvic entrapments","author":"Filler"},{"key":"b15-0260009","series-title":"Lancet","first-page":"659","article-title":"Magnetic resonance neurography","volume":"341","author":"Filler","year":"1993"},{"key":"b16-0260009","series-title":"J Neurosurg","first-page":"299","article-title":"Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology","volume":"85","author":"Filler","year":"1996"},{"key":"b17-0260009","series-title":"Neurol Clin","first-page":"643","article-title":"MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature","volume":"22","author":"Filler","year":"2004"},{"key":"b18-0260009","series-title":"Image Neurography and Diffusion Anisotropy Imaging","author":"Filler","year":"1996"},{"key":"b19-0260009","series-title":"J Pain","first-page":"333","article-title":"Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain","volume":"6","author":"Gajraj","year":"2005"},{"key":"b20-0260009","series-title":"Clin Neurophysiol","first-page":"2315","article-title":"Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T","volume":"116","author":"Hiltunen","year":"2005"},{"key":"b21-0260009","series-title":"AJR Am J Roentgenol","first-page":"561","article-title":"Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique","volume":"181","author":"Hough","year":"2003"},{"key":"b22-0260009","series-title":"Magn Reson Med","first-page":"328","article-title":"Magnetic resonance neurography","volume":"28","author":"Howe","year":"1992"},{"key":"b23-0260009","series-title":"Urology","first-page":"949","article-title":"Anatomy of pudendal nerve at urogenital diaphragm\u2014new critical site for nerve entrapment","volume":"66","author":"Hruby","year":"2005"},{"key":"b24-0260009","series-title":"Eur Radiol","first-page":"2283","article-title":"Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results","volume":"18","author":"Khalil","year":"2008"},{"key":"b25-0260009","series-title":"Neurourol Urodyn","first-page":"306","article-title":"Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria)","volume":"27","author":"Labat","year":"2008"},{"key":"b26-0260009","series-title":"J Lancet","first-page":"286","article-title":"Obturator internus spasm as a cause of pelvic and sciatic distress","volume":"72","author":"Leigh","year":"1952"},{"key":"b27-0260009","series-title":"Surg Radiol Anat","first-page":"163","article-title":"Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome","volume":"28","author":"Loukas","year":"2006"},{"key":"b28-0260009","series-title":"Clin Anat","first-page":"200","article-title":"Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament","volume":"18","author":"Mahakkanukrauh","year":"2005"},{"key":"b29-0260009","series-title":"Dis Colon Rectum","first-page":"186","article-title":"Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia","volume":"42","author":"Mauillon","year":"1999"},{"key":"b30-0260009","series-title":"Anesthesiology","first-page":"1472","article-title":"Sacral postherpetic neuralgia and successful treatment using a paramedial approach to the ganglion impar","volume":"101","author":"McAllister","year":"2004"},{"key":"b31-0260009","series-title":"Can J Anaesth","first-page":"915","article-title":"A modified needle-insideneedle technique for the ganglion impar block","volume":"51","author":"Munir","year":"2004"},{"key":"b32-0260009","series-title":"Eur J Anaesthesiol","first-page":"442","article-title":"Nerve-stimulator-guided repeated pudendal nerve block for treatment of pudendal neuralgia","volume":"23","author":"Naja","year":"2006"},{"key":"b33-0260009","series-title":"J Urol","first-page":"423","article-title":"The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal","volume":"151","author":"Oberpenning","year":"1994"},{"key":"b34-0260009","series-title":"Scand J Urol Nephrol","first-page":"407","article-title":"Entrapment neuropathy of the internal pudendal nerve. Report of two cases","volume":"31","author":"Pisani","year":"1997"},{"key":"b35-0260009","series-title":"Neurourol Urodyn","first-page":"820","article-title":"Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment","volume":"26","author":"Popeney","year":"2007"},{"key":"b36-0260009","series-title":"Am J Phys Med Rehabil","first-page":"479","article-title":"Pudendal nerve entrapment as source of intractable perineal pain","volume":"82","author":"Ramsden","year":"2003"},{"key":"b37-0260009","series-title":"Eur Urol","first-page":"403","article-title":"Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation","volume":"47","author":"Robert","year":"2005"},{"key":"b38-0260009","series-title":"Surg Radiol Anat","first-page":"93","article-title":"Anatomic basis of chronic perineal pain: role of the pudendal nerve","volume":"20","author":"Robert","year":"1998"},{"key":"b39-0260009","series-title":"Arch Androl","first-page":"141","article-title":"Pudendal canal decompression in the treatment of erectile dysfunction","volume":"32","author":"Shafik","year":"1994"},{"key":"b40-0260009","series-title":"Urology","first-page":"199","article-title":"Pudendal canal syndrome: a cause of chronic pelvic pain","volume":"60","author":"Shafik","year":"2002"},{"key":"b41-0260009","series-title":"Orthopedics","first-page":"783","article-title":"Obturator internus bursitis: a common factor in low back pain","volume":"16","author":"Swezey","year":"1993"},{"key":"b42-0260009","series-title":"Radiology","first-page":"653","article-title":"Diffusion-weighted MR neurography of the brachial plexus: feasibility study","volume":"249","author":"Takahara","year":"2008"},{"key":"b43-0260009","series-title":"Abdom Imaging","first-page":"309","article-title":"Pudendal neuralgia: CT-guided pudendal nerve block technique","volume":"24","author":"Thoumas","year":"1999"},{"key":"b44-0260009","series-title":"Pain Physician","first-page":"661","article-title":"Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study","volume":"10","author":"Toshniwal","year":"2007"},{"key":"b45-0260009","series-title":"Am J Obstet Gynecol","first-page":"1233","article-title":"Pudendal neuralgia","volume":"165","author":"Turner","year":"1991"},{"key":"b46-0260009","series-title":"Eur Radiol","first-page":"1018","article-title":"High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging","volume":"18","author":"Viallon","year":"2008"},{"key":"b1-0260009","series-title":"Pain Physician","first-page":"319","article-title":"A novel technique for pudendal nerve block","volume":"7","author":"Abdi","year":"2004"},{"key":"b2-0260009","series-title":"J Urol","first-page":"103","article-title":"Pudendal nerve terminal sensitive latency: technique and normal values","volume":"161","author":"Amarenco","year":"1999"},{"key":"b3-0260009","series-title":"Med Hypotheses","first-page":"349","article-title":"Anatomical basis of chronic pelvic pain syndrome: the ischial spine and pudendal nerve entrapment","volume":"59","author":"Antolak","year":"2002"},{"key":"b4-0260009","series-title":"Dis Colon Rectum","first-page":"406","article-title":"Pudendal canal syndrome and proctalgia fugax: a mechanism creating pain","volume":"41","author":"Bascom","year":"1998"},{"key":"b5-0260009","series-title":"BMC Surg","first-page":"15","article-title":"Pudendal nerve decompression in perineology: a case series","volume":"4","author":"Beco","year":"2004"},{"key":"b6-0260009","series-title":"Am J Obstet Gynecol","first-page":"1663","article-title":"Pudendal neuralgia, a severe pain syndrome","volume":"192","author":"Benson","year":"2005"},{"key":"b7-0260009","series-title":"Reg Anesth Pain Med","first-page":"420","article-title":"Computed tomographyguided pudendal nerve block. A new diagnostic approach to long-term anoperineal pain: a report of two cases","volume":"25","author":"Calvillo","year":"2000"},{"key":"b8-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"431","article-title":"Magic angle effects in MR neurography","volume":"25","author":"Chappell","year":"2004"},{"key":"b9-0260009","series-title":"Int J Clin Pract","first-page":"553","article-title":"C-arm-guided pudendal nerve block: a new technique","volume":"60","author":"Choi","year":"2006"},{"key":"b10-0260009","series-title":"J Urol Medicale Chir","first-page":"98","article-title":"[Treatment of pelvic pain by the enervation by gluteal route of the pudendal nerve.]","volume":"61","author":"Darget","year":"1955"},{"key":"b11-0260009","series-title":"Neurosurg Q","first-page":"1","article-title":"Diagnosis and management of pudendal nerve entrapment syndromes: impact of MR neurography and open MR-guided injections","volume":"18","author":"Filler","year":"2008"},{"key":"b12-0260009","series-title":"Neurosurgery","article-title":"MR Neurography and Diffusion Tensor Imaging: Origins, history & clinical impact of the first 50,000 cases with an assessment of efficacy and utility in a prospective 5,000 patient study group","author":"Filler"},{"key":"b13-0260009","series-title":"J Neurosurg Spine","first-page":"99","article-title":"Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment","volume":"2","author":"Filler","year":"2005"},{"key":"b14-0260009","series-title":"Youmans' Neurological Surgery","article-title":"Piriformis syndrome, obturator internus syndrome, pudendal nerve entrapment and other pelvic entrapments","author":"Filler"},{"key":"b15-0260009","series-title":"Lancet","first-page":"659","article-title":"Magnetic resonance neurography","volume":"341","author":"Filler","year":"1993"},{"key":"b16-0260009","series-title":"J Neurosurg","first-page":"299","article-title":"Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology","volume":"85","author":"Filler","year":"1996"},{"key":"b17-0260009","series-title":"Neurol Clin","first-page":"643","article-title":"MR neurography and muscle MR imaging for image diagnosis of disorders affecting the peripheral nerves and musculature","volume":"22","author":"Filler","year":"2004"},{"key":"b18-0260009","series-title":"Image Neurography and Diffusion Anisotropy Imaging","author":"Filler","year":"1996"},{"key":"b19-0260009","series-title":"J Pain","first-page":"333","article-title":"Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain","volume":"6","author":"Gajraj","year":"2005"},{"key":"b20-0260009","series-title":"Clin Neurophysiol","first-page":"2315","article-title":"Diffusion tensor imaging and tractography of distal peripheral nerves at 3 T","volume":"116","author":"Hiltunen","year":"2005"},{"key":"b21-0260009","series-title":"AJR Am J Roentgenol","first-page":"561","article-title":"Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique","volume":"181","author":"Hough","year":"2003"},{"key":"b22-0260009","series-title":"Magn Reson Med","first-page":"328","article-title":"Magnetic resonance neurography","volume":"28","author":"Howe","year":"1992"},{"key":"b23-0260009","series-title":"Urology","first-page":"949","article-title":"Anatomy of pudendal nerve at urogenital diaphragm\u2014new critical site for nerve entrapment","volume":"66","author":"Hruby","year":"2005"},{"key":"b24-0260009","series-title":"Eur Radiol","first-page":"2283","article-title":"Diffusion tensor imaging and tractography of the median nerve in carpal tunnel syndrome: preliminary results","volume":"18","author":"Khalil","year":"2008"},{"key":"b25-0260009","series-title":"Neurourol Urodyn","first-page":"306","article-title":"Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria)","volume":"27","author":"Labat","year":"2008"},{"key":"b26-0260009","series-title":"J Lancet","first-page":"286","article-title":"Obturator internus spasm as a cause of pelvic and sciatic distress","volume":"72","author":"Leigh","year":"1952"},{"key":"b27-0260009","series-title":"Surg Radiol Anat","first-page":"163","article-title":"Anatomical and surgical considerations of the sacrotuberous ligament and its relevance in pudendal nerve entrapment syndrome","volume":"28","author":"Loukas","year":"2006"},{"key":"b28-0260009","series-title":"Clin Anat","first-page":"200","article-title":"Anatomical study of the pudendal nerve adjacent to the sacrospinous ligament","volume":"18","author":"Mahakkanukrauh","year":"2005"},{"key":"b29-0260009","series-title":"Dis Colon Rectum","first-page":"186","article-title":"Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia","volume":"42","author":"Mauillon","year":"1999"},{"key":"b30-0260009","series-title":"Anesthesiology","first-page":"1472","article-title":"Sacral postherpetic neuralgia and successful treatment using a paramedial approach to the ganglion impar","volume":"101","author":"McAllister","year":"2004"},{"key":"b31-0260009","series-title":"Can J Anaesth","first-page":"915","article-title":"A modified needle-insideneedle technique for the ganglion impar block","volume":"51","author":"Munir","year":"2004"},{"key":"b32-0260009","series-title":"Eur J Anaesthesiol","first-page":"442","article-title":"Nerve-stimulator-guided repeated pudendal nerve block for treatment of pudendal neuralgia","volume":"23","author":"Naja","year":"2006"},{"key":"b33-0260009","series-title":"J Urol","first-page":"423","article-title":"The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal","volume":"151","author":"Oberpenning","year":"1994"},{"key":"b34-0260009","series-title":"Scand J Urol Nephrol","first-page":"407","article-title":"Entrapment neuropathy of the internal pudendal nerve. Report of two cases","volume":"31","author":"Pisani","year":"1997"},{"key":"b35-0260009","series-title":"Neurourol Urodyn","first-page":"820","article-title":"Pudendal entrapment as an etiology of chronic perineal pain: Diagnosis and treatment","volume":"26","author":"Popeney","year":"2007"},{"key":"b36-0260009","series-title":"Am J Phys Med Rehabil","first-page":"479","article-title":"Pudendal nerve entrapment as source of intractable perineal pain","volume":"82","author":"Ramsden","year":"2003"},{"key":"b37-0260009","series-title":"Eur Urol","first-page":"403","article-title":"Decompression and transposition of the pudendal nerve in pudendal neuralgia: a randomized controlled trial and long-term evaluation","volume":"47","author":"Robert","year":"2005"},{"key":"b38-0260009","series-title":"Surg Radiol Anat","first-page":"93","article-title":"Anatomic basis of chronic perineal pain: role of the pudendal nerve","volume":"20","author":"Robert","year":"1998"},{"key":"b39-0260009","series-title":"Arch Androl","first-page":"141","article-title":"Pudendal canal decompression in the treatment of erectile dysfunction","volume":"32","author":"Shafik","year":"1994"},{"key":"b40-0260009","series-title":"Urology","first-page":"199","article-title":"Pudendal canal syndrome: a cause of chronic pelvic pain","volume":"60","author":"Shafik","year":"2002"},{"key":"b41-0260009","series-title":"Orthopedics","first-page":"783","article-title":"Obturator internus bursitis: a common factor in low back pain","volume":"16","author":"Swezey","year":"1993"},{"key":"b42-0260009","series-title":"Radiology","first-page":"653","article-title":"Diffusion-weighted MR neurography of the brachial plexus: feasibility study","volume":"249","author":"Takahara","year":"2008"},{"key":"b43-0260009","series-title":"Abdom Imaging","first-page":"309","article-title":"Pudendal neuralgia: CT-guided pudendal nerve block technique","volume":"24","author":"Thoumas","year":"1999"},{"key":"b44-0260009","series-title":"Pain Physician","first-page":"661","article-title":"Transsacrococcygeal approach to ganglion impar block for management of chronic perineal pain: a prospective observational study","volume":"10","author":"Toshniwal","year":"2007"},{"key":"b45-0260009","series-title":"Am J Obstet Gynecol","first-page":"1233","article-title":"Pudendal neuralgia","volume":"165","author":"Turner","year":"1991"},{"key":"b46-0260009","series-title":"Eur Radiol","first-page":"1018","article-title":"High-resolution and functional magnetic resonance imaging of the brachial plexus using an isotropic 3D T2 STIR (Short Term Inversion Recovery) SPACE sequence and diffusion tensor imaging","volume":"18","author":"Viallon","year":"2008"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/2\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/2\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/2\/article-pE9.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:12:02Z","timestamp":1780733522000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/2\/article-pE9.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,2]]},"references-count":92,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/foc.2009.26.2.e9","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,2]]}}}