Horace Roman: Sciatic Nerve Endometriosis – Prevent Muscle Atrophy Caused by Progressive Denervation
Horace Roman, Honorary Professor of Endometriosis Surgery at the Department of Obstetrics and Gynecology of Aarhus University, shared a post on LinkedIn:
“Sciatic Nerve Endometriosis: Prevent Muscle Atrophy Caused by Progressive Denervation!
Today, I saw a patient with a rather unusual history. She is over 45 years old and has longstanding symptoms affecting her right leg, with pain distributed in a pattern highly suggestive of involvement of the S1 nerve root.
While taking continuous hormonal therapy, approximately 80% of her symptoms are relieved. Nevertheless, I recommended surgery because MRI revealed marked atrophy of the gluteal, piriformis, and obturator internus muscles, suggesting advanced denervation and chronic nerve damage.
The lesion itself is large, extending toward the sciatic notch and appearing ready to leave the pelvis. In addition, the nodule contains multiple T1 hyperintense foci, consistent with hemorrhagic activity and suggesting that the disease remains biologically active despite the significant symptomatic improvement achieved with medical treatment.
This case raises an important question: should surgery be recommended primarily on the basis of progressive neurological damage and muscle denervation, even when symptoms are largely controlled by hormonal therapy? In this patient, the radiological evidence of ongoing nerve involvement and advanced muscle atrophy weighed heavily in favor of surgical management.”
Proceed to the video attached to the post.
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