Domínguez-Páez Miguel, de Miguel-Pueyo Luis Segundo, Medina-Imbroda Juan Manuel, González-García Laura, Moreno-Ramírez Vanessa, Martín-Gallego Alvaro, Socolovsky Mariano, Arráez-Sánchez Miguel Ángel
Servicio de Neurocirugía, Hospital Regional Universitario Carlos Haya, Málaga, España.
Neurocirugia (Astur). 2012 Jul;23(4):170-4. doi: 10.1016/j.neucir.2012.04.009. Epub 2012 Jun 22.
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.
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.
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.
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.
我们报告一例继发于梨状肌子宫内膜异位症导致右侧坐骨神经切迹出现症状性压迫的病例报告，并进行文献综述。
我们报告一名29岁女性，患有两年的右侧慢性坐骨神经痛。在第一年，症状呈发作性且与月经有关。在第二年，坐骨神经痛持续存在，并因坐骨神经肌肉无力导致步态障碍。神经生理学研究证实为单神经病，MRI和PET研究显示坐骨切迹处有肿块，且局部代谢活性病理性增加。为了松解神经并获取组织学样本进行了手术治疗。
患者采用经臀入路治疗，对坐骨神经进行了外膜松解，并切除了梨状肌水平的陈旧性血性囊肿。组织学检查随后报告为子宫内膜异位症。术后坐骨神经痛得到缓解。
相邻子宫内膜异位症导致盆腔外坐骨神经受压非常罕见。肌肉失神经支配和缺乏组织学诊断导致对压迫区域进行手术探查，以松解神经、切除压迫原因并获得明确诊断。该手术改善了所有症状。
