Three-dimensional reconstruction of the innervation of the female pelvis: A review of current methods

The three-dimensional (3D) reconstruction of tissues is a valuable approach for elucidating the anatomy of nerves and plexuses, which are often microscopic in nature and therefore difficult to fully appreciate using gross dissection approaches alone. A common workflow which can be used to generate such 3D models has yet to be comprehensively described. This study aimed to review 3D reconstruction methodologies and findings related to human female pelvic innervation to determine whether there is an optimal methodology and identify the limitations of these approaches. A comprehensive literature review was conducted using keywords including 3D reconstruction, human female pelvic nerves, and innervation. Twenty relevant articles published between 2003 and 2019 were selected for review. The 3D reconstruction of female pelvic innervation generally follows two workflows involving either immunohistochemistry (IHC) (n = 16) or magnetic resonance imaging (MRI) (n = 4). There were commonalities among the general steps reported for 3D tissue reconstruction across these two imaging methodologies. Notably, there was some variability in study methodology across the studies reviewed, suggesting there is not a clear best practice for the reconstruction of these tissues. Information that generates 3D mapping of innervation has important clinical applications, such as informing and optimizing surgical approaches to avoid damage to local innervation. IHC and MRI-based approaches are both feasible for the reconstruction of pelvic innervation, though there are advantages and disadvantages to both. Information from this review can be used to help inform the development of 3D models of female pelvic innervation in the future.