{"paper_id":"bbe97b29-e35a-4d75-883b-fce91b63dca4","body_text":"Abstract\nEndometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient’s period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.\nSimilar content being viewed by others\nAbbreviations\n- EM:\n-\nEndometriosis\n- LSP:\n-\nLumbosacral plexus\n- DIE:\n-\nDeep infiltrative endometriosis\n- MRI:\n-\nMagnetic resonance imaging\n- IUD:\n-\nIntrauterine device\n- MRC:\n-\nMedical research council\n- T1WI:\n-\nT1-weighted image\n- T2WI:\n-\nT2-weighted image\n- FS:\n-\nFat saturated\n- FSE:\n-\nFast spin echo\n- H&E:\n-\nHematoxylin & eosin\nReferences\nAnaf V, Simon P, El Nakadi I, Fayt I, Simonart T, Buxant F, Noel JC (2002) Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod 17:1895–1900\nBotterill EM, Esler SJ, McIlwaine KT, Jagasia N, Ellett L, Maher PJ, Yang N (2015) Endometriosis: does the menstrual cycle affect magnetic resonance (MR) imaging evaluation? Eur J Radiol 84:2071–2079\nCapek S, Howe BM, Amrami KK, Spinner RJ (2015) Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus 39:E14\nEskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin N Am 24:235–258\nGenc B, Solak A, Sahin N, Genc M, Ogul H, Sivrikoz ON, Kantarci M (2014) Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas. Clin Radiol 69:130–136\nMeuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D’Hooghe T (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 92:68–74\nPossover M, Chiantera V (2007) Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril 87:417.e417–419\nPossover M, Baekelandt J, Flaskamp C, Li D, Chiantera V (2007) Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. Minim Invasive Neurosurg 50:33–36\nSiquara de Sousa AC, Capek S, Amrami KK, Spinner RJ (2015) Neural involvement in endometriosis: review of anatomic distribution and mechanisms. Clin Anat 28:1029–1038\nSiquara de Sousa AC, Capek S, Howe BM, Jentoft ME, Amrami KK, Spinner RJ (2015) Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases. Neurosurg Focus 39:E15\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflicts of interest\nNone.\nPatient consent\nThe patients have consented to the submission of the case reports to the journal. This study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000 and 2009.\nAdditional information\nComment\nThis is a very interesting paper on a female patient with symptomatic endometriosis involving her lumbosacral plexus and sciatic nerve at the notch level correlating with anatomical changes involving her lumbosacral plexus seen on MRI with pain at two different time points during her menstrual cycle. Although the findings and response to treatment suggest a cause-and-effect relationship, additional studies to corroborate this hypothesis are needed. This paper further supports this group’s hypothesis that not only tumors but also endometriosis can spread along nerves.\nMichel Kliot\nIllinois, USA\nI\nRights and permissions\nAbout this article\nCite this article\nCapek, S., Amrami, K.K., Howe, B.M. et al. Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica. Acta Neurochir 158, 507–512 (2016). https://doi.org/10.1007/s00701-015-2683-2\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00701-015-2683-2","source_license":"CC0","license_restricted":false}