View
0
Download
0
Category
Preview:
Citation preview
Endometriosis of sciatic nerve
Biomedicum, Helsinki24.9.2009
Päivi HärkkiHelsinki University Central Hospital
Patient history 1 27-year old student was sent to orthopedic
hospital in 2005 due to episodic pain in right buttock and tigh lasting for 10 months
X-ray of the spine, MRI of lumbal spine were normal and physiotherapy was offered
pain occured during periods and lasted one week
also pelvic MRI and electromyography were normal
piriformis syndrome was suspected gynaecological consultation was made
Patient history 2 gynaecologocal examination and TVS were
normal cyclic contraseptive pills were changed to
continuous pills as endometriosis was suspected buttock pain decreased with continuous pills laparoscopy was performed in June, 2006 with no
signs of endometriosis contraseptives were discontinued because of
heavy migraine
Patient history 3 symptoms worsened, pain-free time one
week inpostmenstrum in September, 2007 walking was difficult
because of right footdrop pain in right buttock and tigh was 8/10 in
VAS during menstruation private gynaecologist sent her to
neurologist in January, 2008
Patient history 4 in neurology
severe damage in the sciatic and peroneus nerve in electromyography
spinal MRI was normal 4 cm endometriotic lesion in the
course of right sciatic nerve was seen in pelvic MRI
MRI 1
MRI 2
Patient history 5 gynaecological examination and TVS
were normal in May, 2008 pain was continuous, VAS 10/10 discussion with a neurosurgeon: first
laparoscopy and then a second operation by gluteal approach
Surgery laparoscopy in June, 2008
peritoneal endometriosis in broad ja sacrouterine ligaments which were resected
right ovary was adherent to the pelvic side wall with deep endometriosis
peritoneum was opened lateral to the infundibulopelvic ligament, obturator nerve was identified, sciatic nerve was dissected and hard endometriotic lesion was resected around the nerve near the lateral pelvic wall
most of the lesion was behind the piriformis muscle which not able to remove abdominally
1. Laparoscopy
Netter
Possover et al.Minim Invas Neurosurg 2007;50:33-6
ROM= resection obturatoric muscle
SN= sciatic nerve
ON= obturatoric nerve
2. operation by gluteal approach in July
Netter
Piriformis muscle (PM) was resected to find endometriotic lesion
sciatic nerve
PM
Most of the endometriotic lesion was resected
Postoperatively pain decreased significantly progestin-only pills and physiotherapy were
started she still has a peroneusparesis pain increased in January, 2009 and GnRH-
analog was started again and a new MRI was taken
lesion was not seen in MRI 1 year postoperatively
some patient are treated only with GnRH-agonists without surgery in litterature
Pre- and postoperative MRI
preoperative postoperative
Recommended