ISON Neuropelveological Guidelines for the Diagnosis and Treatment of Pelvic Radiculopathies/neuropathies by Vascular Entrapment.

ISON Neuropelveological Guidelines for the Diagnosis and Treatment of Pelvic Radiculopathies/Neuropathies by Vascular Entrapment These guidelines, developed by the International Society of Neuropelveology (ISON), present the first comprehensive neuropelveological framework for the diagnosis and surgical management of pelvic neuropathies caused by vascular entrapment. The document defines the concept of pelvic neurovascular entrapment syndromes and differentiates them from classical Pelvic Congestion Syndrome (PCS), emphasizing the role of direct neurovascular conflict involving the sacral plexus, pudendal nerve, lumbosacral trunk, and sciatic nerve. The guidelines summarize current knowledge regarding pathophysiology, clinical phenotypes, connective tissue disorders (including Ehlers-Danlos Syndrome), thrombophilic and autoimmune risk factors, neuropelveological examination, Doppler sonography, MRI findings, differential diagnosis, surgical indications, laparoscopic neurovascular decompression techniques, perioperative vascular risks, and postoperative outcomes. Particular attention is given to the neuropelveological approach to chronic pelvic neuropathic pain, sacral radiculopathy, intrapelvic pudendal neuralgia, pelvic compartment syndrome, and neurovascular decompression surgery. The document also highlights the importance of advanced surgical expertise and multidisciplinary management in these complex neurovascular pelvic disorders. These guidelines aim to improve awareness, standardize diagnostic approaches, and establish evidence-based neuropelveological principles for a frequently overlooked but surgically treatable pathology. Keywords Neuropelveology; Pelvic neurovascular entrapment; Vascular entrapment; Sacral radiculopathy; Pudendal neuralgia; Intrapelvic pudendal nerve entrapment; Chronic pelvic neuropathic pain; Pelvic compartment syndrome; Sciatic nerve entrapment; Lumbosacral trunk compression; Pelvic varicosities; Doppler sonography; Pelvic nerve decompression; Neurovascular conflict; Pelvic congestion syndrome; Ehlers-Danlos syndrome; Hypermobility spectrum disorders; Laparoscopic neuropelveology; Pelvic nerve surgery; Pelvic neuropathy; Sacral plexus; Chronic pelvic pain syndrome; Peripheral nerve decompression; Pelvic vascular surgery; ISON Guidelines.