Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique

Lemos, Nucelio; Kamergorodsky, Gil; Plöger, Christine; Castro, Rodrigo Aquino; Schor, Eduardo; Girão, Manoel Joâo Batista Castello

doi:10.1016/j.jmig.2012.02.001

Cited by 15 publications

(20 citation statements)

References 12 publications

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“…The model may shed light on the relatively rare condition of isolated sciatic endometriosis which has been described primarily in case reports(Baker et al, 1966; Cottier et al, 1995; Floyd et al, 2011; Papapietro et al, 2002; Pham et al, 2010; Vercellini et al, 2003). In addition, the model may be relevant for more common cases of endometriosis in the abdomino-pelvic cavity directly affecting nerves (including the sciatic, pudendal, obturator and femoral) or their spinal roots, often in conjunction with other sites (Ceccaroni et al, 2010a; Ceccaroni et al, 2011; Ceccaroni et al, 2010b; Lemos et al, 2012; Possover, 2009; Possover et al, 2007; Possover and Chiantera, 2007; Possover et al, 2011; Waer et al, 2012; Zager et al, 1998). In particular, deep infiltrating endometriosis, observed in 1/3 of laparoscopies performed to investigate severe pelvic pain, has been shown to be associated with intraneurial and perineurial invasion and nerve encapsulation; greater nerve involvement correlated with higher pain levels (Anaf et al, 2000; Ceccaroni et al, 2012; Fraser, 2010; Morotti et al, 2014; Wang et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats

Chen

Xie

Strong

et al. 2015

European Journal of Pain

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Background Endometriosis is a common cause of pain including radicular pain. Ectopic endometrial tissue may directly affect peripheral nerves including the sciatic, which has not been modelled in animals. Methods We developed a rat model for sciatic endometriosis by grafting a piece of autologous uterine tissue around the sciatic nerve. Control animals underwent a similar surgery but received a graft of pelvic fat tissue. Results The uterine grafts survived and developed fluid filled cysts; the adjacent nerve showed signs of swelling and damage. Mechanical and cold hypersensitivity and allodynia of the ipsilateral hindpaw developed gradually over the first two weeks after the surgery, peaked at 2 to 5 weeks, and was almost resolved by 7 weeks. Control animals showed only minor changes in these pain behaviors. Histological signs of inflammation in the uterine graft and in the adjacent nerve were observed at 3 weeks but were resolving by 7 weeks. In vivo fiber recording showed increased spontaneous activity, especially of C fibers, in sciatic nerve proximal to the uterine graft. Several pro-inflammatory cytokines including interluekin-18, VEGF, fractalkine, and MIP-1α, were elevated in the uterine graft plus sciatic nerve samples, compared to samples from normal nerve or nerve plus fat graft. Growth associated protein 43 (GAP43), a marker of regenerating nerve fibers, was observed in the adjacent sciatic nerve as well as in the uterine graft. Conclusions This model shared many features with other rat models of endometriosis, but also had some unique features more closely related to neuropathic pain models.

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Section: Discussionmentioning

confidence: 99%

Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats

Chen

Xie

Strong

et al. 2015

European Journal of Pain

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“…Several authors, however, reported cases of intraneural sciatic nerve EM, which could be explained by perineural spread. 24,30,31,43,56 Waer et al 51 reported a case of EM with perineural spread along the obturator nerve. We wonder if cases of EM with nerve and bone or muscle involvement could be explained by perineural spread along the periosteal and muscle branches.…”

Section: Discussionmentioning

confidence: 99%

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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“…In endometriotic entrapments, the symptoms tend to be cyclic, worsening on the premenstrual and menstrual days and ameliorating or even disappearing on the postmenstrual period [2,7,8].…”

Section: Endometriosismentioning

confidence: 99%

“…Treatment consists of preoperatively identifying the symptoms and determining the topographical localization of the lesions (by means, mainly, of anamnesis and neurological examination and, sometimes, by MRI) and laparoscopically exploring all suspect segments of the plexus, with radical removal of all endometriotic foci and fibrosis [2,7,8] (Fig. 6).…”

Section: Endometriosismentioning

confidence: 99%

Laparoscopic Approach to Intrapelvic Nerve Entrapments

Lemos

Marques

Sparapani

et al. 2015

Journal of Minimally Invasive Gynecology

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Sacral Nerve Infiltrative Endometriosis Presenting as Perimenstrual Right-sided Sciatica and Bladder Atonia: Case Report and Description of Surgical Technique

Cited by 15 publications

References 12 publications

Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats

Sciatic endometriosis induces mechanical hypersensitivity, segmental nerve damage, and robust local inflammation in rats

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

Laparoscopic Approach to Intrapelvic Nerve Entrapments

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