[Sciatica secondary to extrapelvic endometriosis affecting the piriformis muscle. Case report].
OBJECTIVE
We present a case report of symptomatic compression of the right sciatic nerve notch, secondary to piriformis muscle endometriosis, as well as a literature review.


METHODS
We report the case of a 29-year-old woman with 2-year evolution of right chronic sciatica. During the first year, symptoms were episodic and associated with menstruation. During the second year, sciatica was constant and associated with gait disorder due to sciatic musculature weakness. Mononeuropathy was proved by a neurophysiological study, with MRI and PET studies revealing a mass in the sciatic notch and regional pathological increase in metabolic activity. Surgical treatment was performed in order to release the nerve and obtain a histological sample.


RESULTS
The patient was treated by a transgluteal approach, with external neurolysis of the sciatic nerve and resection of an old-blood cyst at the level of the piriformis muscle. This was subsequently reported as endometriosis by histological examination. The sciatica was resolved after surgery.


CONCLUSIONS
Extrapelvic sciatic nerve compression by adjacent endometriosis is very infrequent. Muscle denervation and lack of a histological diagnosis led to surgical exploration of the compression area in order to release the nerve, resect the cause of compression and obtain a definitive diagnosis. The procedure improved all symptoms.
Servicio de Neurocirugía, Hospital Regional Universitario Carlos Haya, Málaga, España.
Miguel
M
Domínguez-Páez
Luis Segundo
LS
de Miguel-Pueyo
Juan Manuel
JM
Medina-Imbroda
Laura
L
González-García
Vanessa
V
Moreno-Ramírez
Alvaro
A
Martín-Gallego
Mariano
M
Socolovsky
Miguel Ángel
MÁ
Arráez-Sánchez
D004715:Endometriosis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009408:Nerve Compression Syndromes; D012584:Sciatic Nerve; D012585:Sciatica