• Amgad S Hanna, Thomas M Staniszewski, Ahmed H Omar, Natalia Guevara-Moriones, Luis Rafael Moscote-Salazar, Keegan H Hilger, and Daniel J Hellebrand.
• Department of Neurological Surgery, University of Wisconsin - Madison, Madison, Wisconsin, USA; Department of Biomedical Engineering, University of Wisconsin - Madison, Madison, Wisconsin, USA. Electronic address: ah2904@yahoo.com.
• World Neurosurg. 2024 Mar 1; 183: e564e570e564-e570.

ObjectiveDeep gluteal syndrome is a clinical condition in which discomfort may arise due to the pathoanatomy of the subgluteal space. We conducted an anatomical exploration to categorize the relationship of the piriformis muscle, sciatic nerve (SN), and pudendal nerve (PN) to the ischial spine (IS) and sacrospinous ligament.MethodsWe analyzed 22 cadavers. The piriformis muscle, SN, and PN were exposed through either a transgluteal approach or a gluteal flap. The relationship of the neural structures to the IS, sacrospinous ligament, and ischial bone as they exit the greater sciatic foramen was observed, and the exit zones were classified as zone A, medial to the IS (entirely on sacrospinous ligament); zone B, on the IS; and zone C, lateral to the IS (entirely on ischial bone).ResultsThe SN was observed either in zone B or zone C in all specimens. The PN was found to be in either zone A or zone B in 97.6% of specimens. The most common combinations were SN in zone B and PN in zone A (type I), and SN in zone C and PN in zone B (type II).ConclusionsThe results from this study show clear anatomical differences in the SN-PN relationship, which may play a role in pain seen in deep gluteal syndrome. Moreover, classification of the SN-IS and PN-IS relationships described in this article will help describe different pathologies affecting the deep gluteal area.Copyright © 2024 Elsevier Inc. All rights reserved.

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