Magnetic resonance neurography for the diagnosis of extrapelvic sciatic endometriosis.
OBJECTIVE
To illustrate magnetic resonance neurography findings of severe sciatic injury and muscle denervation related to deep gluteal endometriosis at the sciatic notch.


METHODS
Case report.


METHODS
Academic teaching hospital.


METHODS
A 39-year-old woman with a 4-year history of sciatica related to the menstrual cycle.


METHODS
Surgical exploration of the sciatic notch for diagnostic confirmation, external neurolysis of the sciatic nerve, and eventual pharmacologic treatment.


METHODS
Magnetic resonance neurography imaging revealed severe neuropathic injury and muscle denervation related to a deep infiltrative endometriotic focus at the sciatic notch, which was confirmed histologically on surgical exploration. Detailed electrodiagnostic and clinical neurologic examinations at initial presentation and during follow-up were obtained for further assessment of nerve degeneration, muscle denervation, and clinical recovery.


RESULTS
Initial gynecologic and eventual laparoscopic evaluation on persisting complaints were without pathological findings. When a progressive weakness of the leg was noted, magnetic resonance neurography revealed a severe axonal damage to the sciatic nerve and denervation of distal target muscles related to a diffuse infiltrative lesion at the sciatic notch. On surgical exploration, extragenital endometriosis was confirmed histologically. Considerable improvement in pain and strength occurred after pharmacologic therapy with a GnRH analogue.


CONCLUSIONS
This is the first report to describe imaging findings of magnetic resonance neurography in severe neuropathic injury of the sciatic nerve and subsequent muscle denervation related to a deep infiltrative gluteal endometriotic focus.
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany. mirko.pham@med.uni-heidelberg.de
Mirko
M
Pham
Claudia
C
Sommer
Carsten
C
Wessig
Camelia-Maria
CM
Monoranu
José
J
Pérez
Guido
G
Stoll
Martin
M
Bendszus
D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011859:Radiography; D012584:Sciatic Nerve / Q000000981:diagnostic imaging / Q000601:surgery; D012585:Sciatica / Q000000981:diagnostic imaging* / Q000601:surgery