Lateral Deep Pelvic Endometriosis. Over Parietal Fascia: Nervous Locations

In: Imaging of Endometriosis: A Comparative Guide of US, MRI and Surgery · 2025 · pp. 211–234 · doi:10.1007/978-3-031-82750-1_11 · W4410897808
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Neural endometriosis, characterized by deep endometriosis compression or distortion of epineural tissue, presents diagnostic and surgical challenges requiring detailed evaluation and advanced imaging techniques like MRI.

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This chapter reviews neural endometriosis, describing it as compression, infiltration, distortion, and irritation of epineural connective tissue (with or without neural entrapment) caused by deep endometriosis and associated fibrosis. It outlines diagnostic requirements including detailed history, targeted neurological and vaginal examinations, and highlights pelvic MRI (including neurography/tractography concepts) as the method of choice, noting that the complex neural anatomy is a challenge for imaging and surgery. It also summarizes advances in treatment, especially neurolysis laparoscopy with nerve-sparing techniques, emphasizing the role of imaging in identifying surgical risk and planning to reduce functional morbidity, while explicitly stating the importance of multidisciplinary care and early diagnosis. This paper is centrally about endometriosis — it focuses on lateral deep pelvic endometriosis over the parietal fascia and the nervous locations involved.

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Abstract

Neural endometriosis is an underestimated condition and a major challenge for surgeons due to the complexity of the anatomy and surgical techniques required and for radiologists because of the complexity of the neural anatomy in imaging methods. It is defined by the compression, infiltration, distortion, and irritation of epineural connective tissue with or without neural entrapment, caused by deep endometriosis (DE) or surrounding associated fibrosis. The diagnosis requires a complete and detailed anamnesis, a targeted neurological and vaginal examination, and using various imaging methods, of which magnetic resonance imaging (MRI) of the pelvis is the method of choice. The treatment of DE has improved greatly in recent decades, especially after the introduction of neurolysis laparoscopy and nerve-sparing techniques, positively impacting neural preservation. Imaging is important in this context because it can identify surgical risks, and a plan can be made to increase surgical security. Anticipating potential nervous injuries in advance changes the preoperative perspective for patients and surgeons, and it has a positive economic impact. A single procedure can be done, discussing it with the patient and pointing out the possible urinary, sexual, and anorectal dysfunctions. And for those with neural involvement, presurgical planning can be included, such as specific physiotherapy. Early diagnosis and multidisciplinary treatment are extremely important to minimize possible comorbidities. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

References

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Springer, Cham. https://doi.org/10.1007/978-3-031-82750-1_11 Download citation DOI: https://doi.org/10.1007/978-3-031-82750-1_11 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-82749-5 Online ISBN: 978-3-031-82750-1 eBook Packages: MedicineMedicine (R0)

Keywords

- Neural endometriosis - Inferior lumbosacral endometriosis - Sciatic endometriosis - Obturator endometriosis - Pudendal endometriosis - Inferior hypogastric plexus endometriosis - Inferior hypogastric nerve endometriosis - Femoral endometriosis - Sacral plexus endometriosis - MRI - MRI neurography - Tractography - Transvaginal ultrasonography

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