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Neurovascular bundle

A Neurovascular bundle (Neuro: Nerve, Vascular: Veins, Lymph vessels and arteries) is a term that describes the typical common path of a vein, artery, lymphatic and nerve that tend to travel through together in the body.

Superficial and deep neurovascular bundles
There are two types of neurovascular bundle: superficial neurovascular bundle and deep neurovascular bundle. As arteries do not travel within the superficial fascia (loose connective tissue under the skin), superficial neurovascular bundles differ from deep neurovascular bundles in both composition and function.For example, in Thoracic Outlet Syndrome, the neurovascular bundle containing the Subclavian Artery and the Brachial Plexus is compressed.

Risks of neurocascular bundles in surgeries
In surgeries, the principle superficial neurovascular bundles at risk are, medially, the great saphenous vein and its accompanying nerve, and laterally, the superficial peroneal nerve. The superficial peroneal nerve origins from the common peroneal nerve near the neck of the fibula and passes between the peroneus longus and brevis muscles, supplying motor branches to these muscles. The superficial branch then continues onto the dorsum of the foot to supply sensory fibers to the skin there.

The main deep neurovascular bundle at risk is the posterior tibial. It lies on the posterior aspect of the tibialis posterior and flexor digitorum longus muscles, and medial to the belly of flexor hallucis longus. It also gives rise to medial plantar artery and lateral plantar artery.

Preserving neuvascular bundles in surgeries
In surgeries, these neurovascular bundles, both superficial and deep, are tried to be protected in order to prevent neuro damages.

The application of preserving neurovascular bundles in surgeries demonstrates that preservation of both neurovascular bundles during nerve-sparing (NS) radical prostatectomy (RP) improves urinary continence and erectile function. Consequently, NS is recommended in elderly men and those with pre-existing erectile dysfunction, who many surgeons would previously have only offered non-NS surgery. It is also found during surgeries that when neurovascular bundles are preserved, the frequency of positive margins was only 5.8 percent.