MRI Diagnosis and Surgical Treatment of Sciatic Nerve Endometriosis: A Case Series

Genital / Reproductive system female, MR, Surgery, Education and training Authors: S.-M. Stanescu, S. Andreea-Bianca, C. Amalia, R. N. Caprariu, R. Stoicescu, E.-R. Stoicescu, D. Manolescu DOI: 10.26044/ecr2026/C-22226 Learning objectives Sciatic nerve endometriosis represents an exceptionally rare and frequently under-recognized manifestation of deep infiltrating endometriosis, characterized by progressive neuropathic pain, cyclical sciatica, and potential irreversible neurological impairment. Due to its insidious onset and overlapping clinical symptomatology with common musculoskeletal and radicular disorders, diagnostic delays remain frequent and may significantly compromise functional outcomes.Magnetic resonance imaging (MRI) constitutes the cornerstone imaging modality for detection, characterization, and comprehensive preoperative mapping of neural endometriotic involvement. The aim of this study is to emphasize the critical diagnostic contribution of MRI...

We retrospectively evaluated a case series of five patients presenting with chronic cyclical pelvic and lower limb pain exacerbated during menstruation, with symptom duration ranging from several months to multiple years. Clinical neurological examination revealed variable degrees of motor deficit, gluteal and posterior thigh pain, and sensory disturbances consistent with sciatic nerve compromise.All patients underwent high-resolution pelvic MRI performed using multiplanar T1-weighted, T2-weighted, and contrast-enhanced fat-suppressed sequences, optimized for neural and soft tissue evaluation. Imaging analysis focused on detecting nerve calibre alterations, intraneural and perineural... Findings and procedure details MRI consistently demonstrated asymmetric thickening and morphological distortion of the sciatic nerve and adjacent pelvic neural plexuses. T1-weighted fat-suppressed sequences revealed focal hyperintense intralesional components corresponding to hemorrhagic and hormonally active glandular endometriotic tissue, representing a hallmark imaging feature of active disease.T2-weighted sequences demonstrated heterogeneous signal characteristics reflecting varying proportions of fibrotic, inflammatory, and glandular components. Post-contrast imaging enabled precise delineation of lesion margins and accurate assessment of neural infiltration, facilitating detailed preoperative anatomical mapping and surgical risk stratification.Integration of imaging findings with clinical and...

MRI plays a pivotal and irreplaceable role in the diagnostic algorithm of sciatic nerve endometriosis, providing superior soft tissue contrast resolution and allowing comprehensive assessment of neural involvement. Imaging hallmarks including nerve thickening, intralesional T1 hyperintense hemorrhagic foci, and contrast-enhancing infiltrative lesions strongly suggest neural endometriotic infiltration.This case series underscores the fundamental importance of MRI-guided surgical planning within a multidisciplinary framework. Early and accurate radiological diagnosis is essential to enable timely surgical intervention, prevent permanent neurological sequelae, and optimize long-term functional outcomes in patients with... Personal information and conflict of interest S-M. Stanescu: Nothing to disclose S. Andreea-Bianca: Nothing to disclose C. Amalia: Nothing to disclose R. N. Caprariu: Nothing to disclose R. Stoicescu: Nothing to disclose E-R. Stoicescu: Nothing to disclose D. Manolescu: Nothing to disclose

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