Papadopoulos S M, McGillicuddy J E, Messina L M
Department of Surgery, University of Michigan, Ann Arbor.
Neurosurgery. 1989 Jun;24(6):926-8. doi: 10.1227/00006123-198906000-00025.
A pseudoaneurysm of the inferior gluteal artery presenting as sciatic nerve compression is reported in a 40-year-old woman. Following a transvaginal needle biopsy for endometriosis, the patient developed left sciatic pain and a nonpulsatile mass palpable in the left buttock thought to represent a pyriformis hematoma. Sequential computed tomographic scans were consistent with this diagnosis. Persistent pain and progression of neurological deficits led to surgical exploration. Posterior exposure of the pyriformis muscle and proximal sciatic nerve revealed a large pseudoaneurysm of the inferior gluteal artery compressing the nerve. A laparotomy was performed and the internal iliac artery was ligated, followed by evacuation of the aneurysm contents and repair of the aneurysm neck via a posterior approach. The patient has remained pain-free with progressive improvement in neurological function after 1 year follow-up. Aneurysms of the gluteal artery are unusual, predominantly occur after significant pelvic trauma, and rarely present as sciatica. Pertinent aspects of the patient history and clinical findings are atypical for discogenic sciatica. Because of the rarity of this entity, preoperative diagnosis is usually not achieved. Angiography or magnetic resonance imaging should be performed in patients with atypical sciatica and a mass in the region of the proximal sciatic nerve, particularly after trauma.
本文报道了一名40岁女性，其臀下动脉假性动脉瘤表现为坐骨神经受压。在因子宫内膜异位症行经阴道穿刺活检后，患者出现左侧坐骨神经痛，左侧臀部可触及一个无搏动性肿块，最初认为是梨状肌血肿。连续的计算机断层扫描结果与该诊断相符。持续的疼痛和神经功能缺损的进展促使进行手术探查。梨状肌和坐骨神经近端的后路暴露显示臀下动脉一个大的假性动脉瘤压迫神经。进行了剖腹手术，结扎了髂内动脉，随后经后路排空动脉瘤内容物并修复动脉瘤颈部。经过1年的随访，患者一直没有疼痛，神经功能逐渐改善。臀动脉动脉瘤并不常见，主要发生在严重骨盆创伤后，很少表现为坐骨神经痛。患者病史和临床发现的相关方面对于椎间盘源性坐骨神经痛来说是非典型的。由于这种情况罕见，术前通常无法做出诊断。对于非典型坐骨神经痛且坐骨神经近端区域有肿块的患者，尤其是在创伤后，应进行血管造影或磁共振成像检查。
