Lin Hung-Lin, Chen Jung-Tsung, Liu Yu-Fang, Cho Der-Yang
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan, R.O.C.
J Chin Med Assoc. 2009 Jan;72(1):39-41. doi: 10.1016/S1726-4901(09)70018-8.
Many etiologies may cause sciatica, and intra-abdominal masses usually affect the lumbosacral plexus by local invasion or distal metastases. Lumbosacral plexopathy caused by compression of intra-abdominal tumors instead of invasion is rarely seen. A 67-year-old woman had a 3-month history of progressive neurogenic claudication, lumbago and left L5 radiculopathy with foot drop. Nocturia and progressive abdominal distension with voiding dysfunction were also noted. Imaging studies showed a huge pelvic mass with severe compression of the left lumbosacral trunk. There was no direct invasion of the lumbosacral plexus by the pelvic mass noted in the preoperative imaging studies or intraoperative findings. Bilateral ovarian borderline mucinous cystic tumor with pseudomyxoma peritonei (PMP) was diagnosed, and the sciatica was improved dramatically after subsequent abdominal debulking surgery. Although rare, neural compression caused by PMP and intra-abdominal masses needs to be considered in the differential diagnosis of sciatica.
许多病因可导致坐骨神经痛，腹腔内肿块通常通过局部侵犯或远处转移影响腰骶丛。由腹腔内肿瘤压迫而非侵犯引起的腰骶丛病变很少见。一名67岁女性有3个月进行性神经源性间歇性跛行、腰痛和左L5神经根病伴足下垂病史。还注意到夜尿症以及伴有排尿功能障碍的进行性腹胀。影像学检查显示巨大盆腔肿块，严重压迫左腰骶干。术前影像学检查或术中发现均未提示盆腔肿块直接侵犯腰骶丛。诊断为双侧卵巢交界性黏液性囊性肿瘤伴腹膜假黏液瘤（PMP），随后的腹部减瘤手术后坐骨神经痛明显改善。虽然罕见，但在坐骨神经痛的鉴别诊断中需要考虑PMP和腹腔内肿块引起的神经压迫。
