Introduction: Sciatic nerve endometriosis is a rare but debilitating form of deep infiltrating endometriosis (DIE) that typically presents with cyclical, refractory sciatica. Management requires meticulous surgical planning and a multidisciplinary approach to achieve both neurological relief and fertility preservation. Case Presentation: A 37-year-old nulligravid patient presented with severe, debilitating left-sided sciatica unresponsive to hormonal treatment. Transvaginal ultrasound and pelvic magnetic resonance imaging revealed a large nodule reaching the left obturator internus and piriformis muscles. A complete laparoscopic excision was performed. Complete excision of the nodule infiltrating the obturator internus muscle was achieved, followed by nerve neurolysis. Conclusion: Complete laparoscopic excision offers a safe and effective treatment for sciatic nerve endometriosis, providing excellent symptom relief. This video highlights the necessary anatomical landmarks and surgical technique for safe neurolysis in the context of DIE.
Iacoponi et al. (Tue,) studied this question.