Sciatic nerve and sacral 2 nerve root decompression by aberrant hypogastric vein branch causing persistent sciatica

Abstract

Introduction:The aim of this case to present a woman with neurovascular entrapment causing persistent sciatica. We presented the surgical management and the feasibility, safety, and early postoperative outcomes, as well as step-by-step explanation of the surgical technique that it was enriched via original video footage.Case description:A 29-year-old woman has been suffering from chronic pelvic pain and sciatica for 1 year. She had received medical physical treatment for 6 months and did not have any response to pain. Her visual analog scale score was 8/10 points. Neurovascular entrapment was considered as a preliminary diagnosis. The laparoscopic approach showed that an aberrant hypogastric vein branch compressing the sciatic nerve and sacral 2 nerve root. The decompression of these nerves was performed successfully. The total operation time was 50 min. There was no intraoperative and postoperative complication. The visual analog scale score on the postoperative 24th-h was 1/10 point (on 11-point numeric scale). The patient was discharged on the second day postoperatively. In the first-month follow-up, patient’s visual analog scale score was 7/10 point (on 11-point numeric scale). In the 12th-month follow-up, patient’s pelvic pain has decreased dramatically (visual analog scale score rate was 0/10 point) and also had no dyspareunia.Conclusion:A gynecologist should be aware of diagnosis of vascular entrapment in the chronic pelvic pain. Moreover, knowledge of pelvic neuroanatomy and clinical neurology is mandatory for surgeons. The surgical management of neurovascular entrapment is a safe, feasible, and curative option when performed by experienced surgeons.