Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
Fertil Steril. 2010 Jun;94(1):351.e11-4. doi: 10.1016/j.fertnstert.2009.12.046. Epub 2010 Feb 10.
To illustrate magnetic resonance neurography findings of severe sciatic injury and muscle denervation related to deep gluteal endometriosis at the sciatic notch.
Case report.
Academic teaching hospital.
PATIENT(S): A 39-year-old woman with a 4-year history of sciatica related to the menstrual cycle.
INTERVENTION(S): Surgical exploration of the sciatic notch for diagnostic confirmation, external neurolysis of the sciatic nerve, and eventual pharmacologic treatment.
MAIN OUTCOME MEASURE(S): 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.
RESULT(S): 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.
CONCLUSION(S): 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.
阐明坐骨切迹深部臀内子宫内膜异位症导致严重坐骨神经损伤和肌肉失神经支配的磁共振神经成像表现。
病例报告。
学术教学医院。
一名 39 岁女性，有 4 年与月经周期相关的坐骨神经痛病史。
为明确诊断，对坐骨切迹进行手术探查，坐骨神经外部神经松解术，以及最终的药物治疗。
磁共振神经成像显示坐骨切迹处存在严重的神经病变和肌肉失神经支配，与坐骨切迹处深部浸润性子宫内膜异位灶有关，手术探查证实了这一点。在初始表现和随访期间进行了详细的电诊断和临床神经学检查，以进一步评估神经退行性变、肌肉失神经支配和临床恢复情况。
最初的妇科检查和最终的腹腔镜检查均未发现异常。当腿部出现进行性无力时，磁共振神经成像显示坐骨神经严重轴索损伤，并与坐骨切迹弥漫性浸润性病变相关的远端靶肌肉失神经支配。手术探查证实存在外生殖器子宫内膜异位症。在使用 GnRH 类似物进行药物治疗后，疼痛和力量均有明显改善。
这是首例描述磁共振神经成像在坐骨神经严重神经病变和随后的肌肉失神经支配与深部浸润性臀内子宫内膜异位灶相关成像表现的报告。
