Endometriosis of the conus medullaris causing cyclic radiculopathy

Steinberg, Jeffrey A.; Gonda, David; Muller, Karra A.; Ciacci, Joseph D.

doi:10.3171/2014.7.spine14117

Cited by 15 publications

(11 citation statements)

References 43 publications

(44 reference statements)

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“…9 In their series, Possover and Chiantera 36 reported a case of sciatic nerve EM with extension to the obturator internus muscle-again, a similar pattern to that seen in our case and to that described in perineural cancer spread. 8 We further hypothesize that cases of conus medullaris EM could be explained as an extension of the same process intradurally along the sacral and lumbar nerve roots, 20,44 possibly with subsequent intradural seeding 19 as proposed in perineural spread of prostate cancer. 10 …”

Section: Discussionmentioning

confidence: 81%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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Sciatic nerve endometriosis (EM) is a rare presentation of retroperitoneal EM. The authors present 2 cases of catamenial sciatica diagnosed as sciatic nerve EM. They propose that both cases can be explained by perineural spread of EM from the uterus to the sacral plexus along the pelvic autonomie nerves and then further distally to the sciatic nerve or proximally to the spinal nerves. This explanation is supported by MRI evidence in both cases. As a proof of concept, the authors retrieved and analyzed the original MRI studies of a case reported in the literature and found a similar pattern of spread. They believe that the imaging evidence of their institutional cases together with the outside case is a very compelling indication for perineural spread as a mechanism of EM of the nerve.

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Section: Discussionmentioning

confidence: 81%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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“…The perineural spread theory is not limited to the pelvic nerves, as the involvement of the central nervous system also has been reported [ 28 ]. This includes the cerebellar vermis of the brain, frontal and parietal lobes, cauda equina, and conus medullaris [ 31 - 35 ]. The supporting evidence for endometriosis spread via the perineural approach is endometriotic lesions’ expression of nerve growth factor and the presence of the nerve growth factor (NGF) receptor (Trk-A) on the pelvic nerves [ 36 ].…”

Section: Reviewmentioning

confidence: 99%

The Clinical Anatomy of Endometriosis: A Review

Alimi¹,

Iwanaga²,

Loukas³

et al. 2018

Cureus

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Endometriosis is a gynecological disorder identified by the presence of ectopic endometrial tissue outside the uterus. Largely, it affects reproductive-aged women and is a major cause of infertility. Clinical manifestations of endometriosis include dyspareunia, cyclic menstrual pain, chronic pelvic pain, and dyschezia, all of which can affect the patient’s quality of life and health severely; therefore, it is paramount that medical treatment is initiated as soon as endometriosis is suspected clinically. In this review, we examine the known anatomic principles of endometriosis in the literature and outline ways to manage patients with this condition better.

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“…(Steinberg et al, 2014) Conus medullaris Catamenial radicular pains; intramedullary hematoma of the conus.…”

Section: Perineural Spread -Supporting Evidence On Subcellular Levelmentioning

confidence: 99%

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

et al. 2015

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Endometriosis (EM) is an infrequent cause of peripheral neuropathy, most commonly sciatic. Perineural spread has recently been introduced as an alternate explanation for cases of lumbosacral or sciatic nerve EM. We performed a literature review to collect all reported cases of peripheral and central nervous system EM in search of anatomic patterns of involvement; potentially to support the perineural spread theory. If available, intraneural invasion and presence of peritoneal EM were recorded. The search revealed 83 articles describing 365 cases of somatic peripheral nervous EM and 13 cases of central nervous EM. The most frequently involved site was the sacral plexus (57%, n = 211), followed by the sciatic nerve (39%, n = 140). Other nerves were reported in significantly smaller numbers. Ninety seven percent (97%, n = 355) of peripheral nerve cases presented with pain, 20% (n = 72) reported weakness and 31% (n = 114), numbness. Thirty four percent (34%, n = 38) had solely intraneural EM of which 89% (n = 33) had no peritoneal EM (percentage based on available information). In the central nervous system, the conus medullaris and/or cauda equina constituted the majority of cases with 54% (n = 7). Apart from perineural spread, other discussed mechanisms include retrograde menstruation with peritoneal seeding, hematogenous and lymphogenous spread, stem cell implantation either hematogenously or via retrograde menstruation with subsequent EM differentiation, and coelomic or Müllerian duct metaplasia. We believe this literature review supports perineural spread as an alternate mechanism for EM of nerve, particularly the subgroup with intraneural EM and without peritoneal disease.

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Endometriosis of the conus medullaris causing cyclic radiculopathy

Cited by 15 publications

References 43 publications

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

The Clinical Anatomy of Endometriosis: A Review

Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

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