BACKGROUND
Intraneural cyst (ganglion) of peripheral nerve is pretty rare, but encountered pathology. The most common localization of ganglion is peroneal nerve, ganglion of sciatic nerve occurs much more rare. Treatment of intraneural cyst is commonly surgical. Intervention is usually done with open approach with revision and nerve neurolysis, opening of the cyst and its evacuation. Open surgery has some disadvantages: massive skin and soft tissue trauma, blood loss, risk of infectious complications, long rehabilitation period. Development of endoscopic technique of revision of sciatic nerve and evacuation of cyst will allow minimize these problems, fasten and relieve rehabilitation period for the patient
OBJECTIVE
Describe clinical case of endoscopic treatment of the patient with intraneural cyst (ganglion) of sciatic nerve, evaluate clinical results of treatment at 6 months follow-up.
MATERIAL AND METHODS
40-years old male patient with intraneural cyst (ganglion) of right sciatic nerve at piriformis area. The patient suffered from deep gluteal pain syndrome, motor and sensitive impairments in foot and shin. Conservative treatment was ineffective. Instrumental investigation included MRI, ultrasound, ENMG. According to MRI the size of the cyst was 1.95×2.7×1.5 cm. The patient was performed endoscopic neurolysis of right sciatic nerve at piriformis area under general anesthesia, revision of the nerve, opening of the cyst and its evacuation.
RESULTS
There was no complication after surgery. Final examination was done at 6 months after surgery. The patient noticed decreasing of pain syndrome according to VAS scale (from 6 to 1 cm), restoration of motor function according to BMRC (from 3 to 5 points), elimination of sensitive impairments according to Seddon scale (from 3 to 4 points). Level of lower limb functional activity according to LEFS scale improved from 53 to 76 points. The patient totally recovered his life and sport level activity.
CONCLUSION
The clinical case showed the possibility of performing of endoscopic neurolysis of sciatic nerve with intraneural cyst evacuation at piriformis muscle area with excellent clinical result at 6 months follow-up.