Isolated Sciatic Nerve Endometriosis

Abstract

Study Objective Sciatic Nerve Endometriosis is rarely observed. Symptoms include sciatica, gluteal pain, and sometimes, locomotion problems without bladder dysfunction or Pudendal pain. Clinical gynecological pelvic examination in these patients is usually unremarkable. Design Case report with surgical technical details and anatomical landmark discussion. Setting Gynecologic Endoscopic Unit in a Tertiary Care Private Clinic. Patients or Participants 46-year-old patient with multiple leiomyomas and chronic pelvic pain. 3 years with progressive sciatic pain (right hip and buttock pain), alteration of sensation along L5 and S1 dermatomes with a perceived reduced power in the right ankle. All showed severe exacerbation during menstruation. Besides uteromegaly, her pelvic gynecological examination was normal. Pelvic MRI showed a 3.4 cm endometriotic lesion over the pelvic segment of her right sciatic nerve, before exiting the great sciatic foramen. Interventions Laparoscopic access to the Lumbosacral space and sciatic nerve cold scissors shaving. Measurements and Main Results The patient recovered well from her surgery. She complained of exacerbation of neurological symptoms immediately after surgery, specifically lower limb paresthesia over the first few days. After a week she had significant improvement of pain and after one year she is asymptomatic. Conclusion Exploration of lumbosacral space should not be undertaken lightly due to its complex anatomy and potential for serious injury to the major neurovascular structures. Once the procedure is started, resection of the lesions must be fully completed to avoid further surgical interventions which are always more challenging than the preceding one.