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Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica

  • Case Report - Neurosurgical Techniques
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Abstract

Endometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient’s period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.

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Abbreviations

EM:

Endometriosis

LSP:

Lumbosacral plexus

DIE:

Deep infiltrative endometriosis

MRI:

Magnetic resonance imaging

IUD:

Intrauterine device

MRC:

Medical research council

T1WI:

T1-weighted image

T2WI:

T2-weighted image

FS:

Fat saturated

FSE:

Fast spin echo

H&E:

Hematoxylin & eosin

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Stepan Capek & Robert J. Spinner

  2. 2nd Faculty of Medicine, Charles University in Prague, V Uvalu 84, 150 06, Prague 5, Czech Republic

    Stepan Capek

  3. Department of Radiology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA

    Kimberly K. Amrami, Benjamin M. Howe & Mark S. Collins

  4. Department of Neurology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA

    Paola Sandroni

  5. Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA

    John C. Cheville

Authors
  1. Stepan Capek
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  2. Kimberly K. Amrami
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  3. Benjamin M. Howe
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  4. Mark S. Collins
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  5. Paola Sandroni
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  6. John C. Cheville
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  7. Robert J. Spinner
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Corresponding author

Correspondence to Robert J. Spinner.

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None.

Patient consent

The patients have consented to the submission of the case reports to the journal. This study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000 and 2009.

Additional information

Comment

This is a very interesting paper on a female patient with symptomatic endometriosis involving her lumbosacral plexus and sciatic nerve at the notch level correlating with anatomical changes involving her lumbosacral plexus seen on MRI with pain at two different time points during her menstrual cycle. Although the findings and response to treatment suggest a cause-and-effect relationship, additional studies to corroborate this hypothesis are needed. This paper further supports this group’s hypothesis that not only tumors but also endometriosis can spread along nerves.

Michel Kliot

Illinois, USA

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Capek, S., Amrami, K.K., Howe, B.M. et al. Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica. Acta Neurochir 158, 507–512 (2016). https://doi.org/10.1007/s00701-015-2683-2

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  • DOI: https://doi.org/10.1007/s00701-015-2683-2

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