TY - JOUR
T1 - Vascular malformations, rare causes of sciatic neuropathy
T2 - A case series
AU - Van Gompel, Jamie J.
AU - Griessenauer, Christoph J.
AU - Scheithauer, Bernd W.
AU - Amrami, Kimberly K.
AU - Spinner, Robert J.
PY - 2010/10
Y1 - 2010/10
N2 - BACKGROUND: Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of sciatic neuropathy outside the neural foramina are uncommon. OBJECTIVE: To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology. METHODS: Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast. RESULTS: Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater. CONCLUSION: In patients with sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.
AB - BACKGROUND: Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of sciatic neuropathy outside the neural foramina are uncommon. OBJECTIVE: To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology. METHODS: Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast. RESULTS: Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater. CONCLUSION: In patients with sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.
KW - Neuropathy
KW - Peripheral nerve
KW - Sciatic
KW - Vascular malformation
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UR - http://www.scopus.com/inward/citedby.url?scp=77957993143&partnerID=8YFLogxK
U2 - 10.1227/NEU.0b013e3181ecc84e
DO - 10.1227/NEU.0b013e3181ecc84e
M3 - Article
C2 - 20881578
AN - SCOPUS:77957993143
SN - 0148-396X
VL - 67
SP - 1133
EP - 1142
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -