{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:34:32Z","timestamp":1784871272744,"version":"3.55.0"},"reference-count":25,"publisher":"Galenos Yayinevi","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Facts Views Vis ObGyn"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>Background: Endometriosis of the sciatic nerve (ESN) is considered a rare disease. How can endometriosis develop within the sciatic nerve; a structure which has nothing in common with the uterus either anatomically or functionally, and why it occurs in the absence of any retroperitoneal\/parametric endometriosis, is unknown. A better understanding of the pathophysiology of this enigmatic disease may improve its diagnosis and therapy.\n\nMaterials and Methods: From a pool of 452 patients operated for ESN, only patients with \u201cisolated\u201d endometriosis of the sciatic nerve\u201d confirmed at laparoscopy were included in this study. Patients with suspicion of ESN by extension from a parametric, ovarian or other intraperitoneal deeply infiltrating endometriosis were excluded from this study.\n\nMain outcome measure: All information acquired during the preoperative patient\u2019s medical history and clinical examination were collected and compared with the morphological aspects of the disease observed by the laparoscopic treatment. Patients were classified into three groups according to the time interval between the onset of sciatic pain and the time of surgery: less than 1 year (Group 1), between 1 and 3 years (Group 2), and more than 3 years (Group 3).\n\nResults: Two hundred sixty-seven consecutive patients were included in this study. In Group 1 (n=67), 76% of the patients presented with cyclical sciatica, without sensory or motor disorders of the lower limbs. Laparoscopic exploration found in the great majority of these patients only the presence of an isolated endometrioma in the nerve itself, the size of which was proportional to the time elapsed since the onset of pain. In Group 2 (n=83), pain had become constant in 91% of the patients with neurological disorders of the lower limb (foot drop, Trendelenburg gait, atrophied muscles) in about 30% of patients. Laparoscopic examination revealed, in addition to intraneural cystic lesions, a retroperitoneal fibrosis in more than 80% of the patients. In the third group (N=117), more than 80% of the patients presented with neurological disorders of the lower limb, with, on laparoscopic examination, massive retroperitoneal fibrosis with endometriomas in the nerve and adjacent pelvic wall muscles in all patients and an infiltration of the obturator nerve in 41% of patients.\n\nConclusions: The different morphologic aspects of ESN do not correspond to different forms of the disease, but obviously to one single disease at different stages of its evolution. ENS starts first with the development of an endometrioma within the sciatic nerve, then develops in a second step a perineural fibrosis that expands into the whole retroperitoneal space and finally involves surrounding anatomical structures. The ESN is a very particular pathology because it induces a completely new aspect on the pathogenesis of endometriosis: all hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread or the metaplasia theory cannot explain the pathogenesis of this disease. ESN obviously does not develop from \u201cgenital metastatic cells\u201d. A possible hypothesis for explanation the pathogenesis of ESN, could consist in the development of endometriosis of the nerve from progenitor stem cells present within the nerve, pluripotent cells which, for an as yet unknown reason (possibly in connection with iterative inflammations and micro-damages of the nerve itself), mutate and proliferate to form endometriosis.<\/jats:p>","DOI":"10.52054\/fvvo.13.4.047","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:18:01Z","timestamp":1642119481000},"page":"369-375","source":"Crossref","is-referenced-by-count":14,"title":["Laparoscopic morphological aspects and tentative explanation of the aetiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients"],"prefix":"10.52054","volume":"13","author":[{"given":"M","family":"Possover","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2811","published-online":{"date-parts":[[2022,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Anaf V, Simon PH, Nakadi IEL et al. Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodules. Hum Reprod. 2000;15:1744-50.","DOI":"10.1093\/humrep\/15.8.1744"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Carr MJ, Toma JS, Johnston APW et al. Mesenchymal precursor cells in adult nerves contribute to mammalian tissue repair and regeneration. Cell Stemm Cell. 2019;24:240-56.","DOI":"10.1016\/j.stem.2018.10.024"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Cousins FL, Xiao L, Gargett CE. Adult stem cells in the pathogenesis and treatment of endometrioisis. J Endometriosis and Pelvic Pain disorders. 2017;11:1-11.","DOI":"10.5301\/jeppd.5000310"},{"key":"ref3","unstructured":"Czaja K, Fornaro M, Geuna S. Neurogenesis in the adult peripheral nervous system. Neural Regen Res. 2012;7:1047-54."},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Du H, Taylor HS. Contribution of bone marrow-derived stem cells to endometrium and endometriosis. 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Hum Reprod. 2008; 23: 2202-9.","DOI":"10.1093\/humrep\/den259"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Ohara S, Roth KA, Beaudet LN, et al. Transganglionic neuropeptide Y response to sciatic nerve injury in young and ages rats. J Neuropathol Exp Neurol. 1994;53:646-62.","DOI":"10.1097\/00005072-199411000-00012"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Possover M, Chiantera V. Isolated infiltrative endometriosis of the sciatic nerve: about three cases. Fertil Steril. 2007;87:417-9.","DOI":"10.1016\/j.fertnstert.2006.05.084"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Possover M, Tersiev P, Doychin A. Comparative study of the neuropeptide-Y sympathic nerves in endometriotic involved and noninvolved sacrouterine ligaments in women with pelvic endometriosis. JMIG. 2009;16:340-3.","DOI":"10.1016\/j.jmig.2009.02.012"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Possover M, Schneider T, Henle KP. 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