Neural involvement in endometriosis: Review of anatomic distribution and mechanisms

Ana Caroline Siquara de Sousa, Ana C Siquara De Sousa, Stepan Capek, Kimberly K Amrami, Robert J Spinner
Clinical anatomy (New York, N.Y.) · 2015 · vol. 28(8) , pp. 1029–1038 · doi:10.1002/ca.22617 · W2164255707
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This literature review found the sacral plexus and sciatic nerve are most commonly affected by endometriosis, with intraneural invasion occurring without peritoneal disease supporting perineural spread as a mechanism.

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Abstract

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. Clin. Anat. 28:1029–1038, 2015. © 2015 Wiley Periodicals, Inc.

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Central Nervous System Diseases Endometriosis Peripheral Nervous System Diseases Cauda Equina Cauda Equina Central Nervous System Diseases Endometriosis Endometriosis Female Humans Hypesthesia Hypesthesia Lumbosacral Plexus Lumbosacral Plexus Muscle Weakness Muscle Weakness Pain Pain Peripheral Nervous System Diseases Peripheral Nervous System Diseases

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (100)

Cited by (47)

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