Elsevier

World Neurosurgery

Volume 89, May 2016, Pages 208-214
World Neurosurgery

Original Article
The Important Liaison Between Onuf Nucleus–Pudendal Nerve Ganglia Complex Degeneration and Urinary Retention in Spinal Subarachnoid Hemorrhage: An Experimental Study

https://doi.org/10.1016/j.wneu.2016.01.082Get rights and content

Objective

The Adamkiewicz artery (AKA) supplies pudendal nerve roots and conus medullaris. The aim of this study was to elucidate if there is any relationship between neurodegenerative changes of the Onuf nucleus (ON)–pudendal nerve ganglia complex secondary to vasospasm of the AKA after spinal subarachnoid hemorrhage (SAH).

Methods

This study was conducted on 22 rabbits, which were randomly divided into 3 groups: control (n = 5), sham (n = 5), and spinal SAH (n = 12). Experimental spinal SAH was induced at the L2 level. After 2 weeks, the ON–pudendal nerve ganglia complex and AKA were examined histopathologically. Bladder volume values were estimated, and results were analyzed statistically.

Results

Two animals died within the first week of experiment. Histopathologically, severe vasospasm of the AKA and neuronal degeneration and neuronal apoptosis were observed in the ON–pudendal nerve ganglia complex in 5 animals of the SAH group. The mean volume of the imaginary AKA, mean bladder volumes, and degenerated neuron densities of ON and pudendal nerve ganglia were estimated. We found that vasospasm of the AKA led to numerous neuron degenerations in ON and pudendal ganglia and consequently urinary retention (P < 0.005).

Conclusions

ON–pudendal nerve ganglia complex degeneration secondary to vasospasm of the AKA may be a cause of urinary retention after spinal SAH.

Introduction

Spinal subarachnoid hemorrhage (SAH) is a devastating condition,1 and the understanding of this pathology continues to evolve. Vasospasm after spinal SAH can lead to damage of the third and the second sensory neurons of the spinocortical sensory pathways and result in neurodegeneration of dorsal root ganglion (DRG).1, 2 Turkmenoglu et al.1 and Ozturk et al.3 investigated the complications from Adamkiewicz artery (AKA) vasospasm. Interruption of the AKA in spinal SAH leads to spinal cord ischemia and changes in DRG because the blood supply of the lower spinal cord is heavily dependent on this artery1; however, there is no study to our knowledge about the occurrence of urinary retention in spinal SAH with AKA vasospasm. Parasympathetic fibers arising from Onuf nucleus (ON) located in the conus medullaris and somatosensitive fibers of pudendal nerves are responsible for urination. In this study, the relationship between ON degeneration induced by spinal SAH, terminal spinal cord ischemia, and urinary retention was examined.

Section snippets

Materials and Methods

This study was conducted on 22 adult male New Zealand rabbits (3.7 ± 0.4 kg) (Ataturk University, Erzurum, Turkey) that were randomly divided into 3 groups: control (n = 5), sham (n = 5), and spinal SAH (n = 12). The animal protocols were approved by the Ethics Committee of Ataturk University, Medical Faculty.

Results

Intestinal and bladder distention, paraparesis, spastic or flask gait disturbances, and limitations of tail movements were observed in some surviving animals of the SAH group. Within the first week, 2 rabbits in the SAH group died. In the remaining rabbits of the SAH group (n = 10), the following were observed: unconsciousness (n = 1; 10%), convulsion (n = 2; 20%), meningeal irritation signs (n = 2; 20%), bowel dysfunction and urinary retention (n = 7; 70%), and paraparesis (n = 1; 10%).

Discussion

SAH affecting the spinal cord is very rare, and may have disastrous consequences.1 The AKA is the most important feeding artery of the thoracolumbar spinal cord, also known as the great anterior radiculomedullary artery.3 Vasospasm of cerebral arteries is a major complication of SAH. Vasospasm also occurs in extracerebral arteries. For example, Ozturk et al.3 and Turkmenoglu et al.1 reported that vasospasm of the AKA after spinal SAH leads to changes in DRG. Acute hypoperfusion of the AKA might

Conclusions

The present study shows that the interruption of the AKA by vasospasm may lead to ON and pudendal nerve ganglia degeneration. Urinary retention can occur as a result. Our results are important for understanding the neuropathophysiologic mechanism of bladder distention after spinal SAH. Documenting AKA vasospasm in this situation can aid in the planning of future experimental and clinical studies and determining the clinical importance of this artery.

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