Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Neurosurg Spine. 2011 Feb;14(2):281-9. doi: 10.3171/2010.10.SPINE09162. Epub 2010 Dec 24.
Sciatic (catamenial) radiculopathy, waxing and waning with the menstrual cycle, is an uncommon condition typically caused by pelvic endometriosis affecting the lumbosacral plexus or proximal sciatic nerve. The authors describe a woman with catamenial sciatica caused by endometriosis affecting the sciatic nerve trunk in the upper thigh. Symptomatic with leg pain for 5 years, this patient developed gluteal atrophy and sensory loss and decreased strength in the L-5 dermatomyotome, a distribution confirmed by electromyography. Magnetic resonance imaging suggested thickening of the sciatic nerve at and distal to the sciatic notch. At operation the nerve showed extrinsic and intrinsic abnormality, proven to be endometriosis. Her symptoms improved, and she began gonadotropin-releasing hormone agonist therapy for further suppression. This very unusual case shows that endometriosis can affect the sciatic nerve over a range of territory inside and outside the pelvis, and that surgery must be appropriately directed to avoid negative exploration. Surgical decompression achieves good relief of symptoms, and medical therapy also allows sustained suppression of this disease.
与月经周期相关的坐骨（周期性）神经根病，呈周期性变化，是一种不常见的病症，通常由影响腰骶丛或坐骨近端神经的盆腔子宫内膜异位症引起。作者描述了一名女性周期性坐骨神经痛，其病因是大腿上段坐骨神经干受累的子宫内膜异位症。该患者腿痛症状持续 5 年，出现臀肌萎缩、感觉丧失和 L-5 皮节的肌力下降，这一分布通过肌电图得到证实。磁共振成像提示坐骨切迹处和其远端坐骨神经增粗。手术时发现神经存在外在和内在异常，证实为子宫内膜异位症。她的症状得到改善，并开始接受促性腺激素释放激素激动剂治疗以进一步抑制病情。这个非常罕见的病例表明，子宫内膜异位症可影响骨盆内外大范围的坐骨神经，手术必须有针对性，以避免不必要的探查。手术减压可有效缓解症状，药物治疗也可持续抑制该疾病。
