Superior gluteal vein entrapment: targeted surgical decompression for aberrant anatomy

OBJECTIVE: To demonstrate laparoscopic identification and treatment of aberrant superior gluteal vein-related intrapelvic sciatic nerve compression using a targeted neurovascular decompression approach. DESIGN: Video article SETTING: A single-case from a specialized endometriosis center. PATIENT(S): A 33-year-old woman presented with noncyclical right-sided sciatica radiating from the buttock to the heel, requiring a cane several times weekly, along with chronic pelvic pain and cyclic bowel and bladder symptoms consistent with peritoneal endometriosis with suspected neuropathic involvement. Her surgical history included multiple endometriosis excision procedures, hysterectomy, and adnexal surgery. Computed tomography and magnetic resonance imaging of the lumbosacral plexus was unremarkable. The patient provided written consent for publication and online distribution of the video (including social media, the journal website, and scientific databases). EXPOSURE: Laparoscopic excision of peritoneal implants was followed by stepwise retroperitoneal dissection with ureterolysis, mapping of the obturator nerve, and targeted exploration of the proximal sciatic nerve with. a lateral approach. A markedly dilated aberrant superior gluteal vein crossing and compressing the proximal sciatic nerve was identified and treated with clip ligation and precise transection. MAIN OUTCOME MEASURES: Completion of decompression without complications and improvement in neuropathic pain at 6- and 12-month follow-up. RESULTS: Decompression restored normal nerve contour with meticulous hemostasis. At 6 months, the patient reported substantial improvement in right-sided sciatica and mobility without new neurologic deficits. CONCLUSION: Aberrant pelvic venous anatomy can cause clinically significant intrapelvic sciatic nerve compression even in the absence of imaging findings; however, this single-case surgical demonstration, performed in a highly specialized setting, requires expertise. It is worth acknowledging that permanent metal clips were used for venous ligation in this case. Bipolar energy devices or absorbable polymeric clips may be preferable alternatives in future applications, may reduce the risk of long-term nerve-related complications.