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Professor Marc Possover, world-renowned pioneer in neuropelviology, discusses when and why to be concerned about sciatic endometriosis. He explains the critical distinction between regular endometriosis near the sciatic nerve versus endometriosis growing within the nerve itself, which requires specialized neurosurgical intervention.
• Cyclical sciatic pain during menstruation may suggest endometriosis involvement
• Sensory disorders, numbness, and weakness are serious warning signs requiring immediate attention
• Vascular entrapment is the most common cause of sciatic pain in the pelvis
• Endometriosis of the sciatic nerve requires specifically trained neuropelviological surgeons, not just gynecologists
• Improper surgery on the sciatic nerve can cause permanent disability like foot drop
• A comprehensive neuropelviological workup is essential before any surgical intervention
• True sciatic nerve endometriosis surgery is among the most difficult and dangerous pelvic procedures
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Quick Connect Introduction
Speaker 1
0:00
Life
moves
fast
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should
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biggest
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Speaker 1
0:41
Today's
guest
has
built
his
career
on
a
bold
but
vital
belief
that
suffering
pain
should
not
be
a
life
sentence
.
And
for
Professor
Mark
Possover
,
that
belief
isn't
just
a
philosophy
,
it's
a
mission
.
As
a
world-renowned
pioneer
in
neuropelviology
yes
,
you
heard
that
right
he
has
transformed
how
we
understand
and
treat
chronic
pelvic
pain
,
especially
when
the
source
is
elusive
or
deemed
untreatable
.
His
work
bridges
the
worlds
of
gynecology
,
neurology
and
minimally
invasive
surgery
to
target
the
pelvic
nerve
directly
,
often
bringing
relief
to
patients
who've
been
told
to
simply
live
with
it
.
His
methods
have
given
hope
to
countless
people
who
have
felt
like
they've
run
out
of
options
.
Please
help
me
in
welcoming
Professor
Marc
Posobert
.
When
should
we
be
concerned
for
sciatic
endometriosis
?
Speaker 2
1:30
To
say
I
have
cyclical
pain
.
That
means
sciatic
pain
every
month
during
men's
bleeding
.
So
it
is
an
endometriosis
.
That
is
much
too
easy
.
But
once
a
patient
starts
to
develop
some
,
too
easy
.
But
once
a
patient
starts
to
develop
some
sensory
disorder
,
with
some
numbness
in
the
genitourinal
area
,
in
the
lower
back
,
in
the
buttock
or
in
the
sciatic
nerve
area
and
even
more
,
but
that
is
even
more
or
less
a
late
diagnosis
,
when
patients
are
starting
to
develop
weakness
,
with
foot
drop
,
for
example
,
or
difficulty
for
contraction
,
flexion
of
the
toes
,
then
the
next
appointment
,
the
next
door
,
is
a
gynecologist
,
with
the
hope
that
you
will
know
this
pathology
,
because
still
a
lot
of
colleagues
don't
know
that
endometriosis
,
sciatic
nerve
exists
,
may
exist
.
Speaker 1
2:22
But
it's
not
always
sciatic
nerve
endometriosis
.
It
can
be
just
close
to
always
sciatic
nerve
endometriosis
.
It
can
be
just
close
to
the
sciatic
nerve
right
.
Speaker 2
2:27
The
most
frequent
pathology
that
induce
sciatic
pain
in
the
pelvis
is
a
vascular
entrapment
,
and
that
by
far
,
and
I
completely
agree
.
Endometriosis
close
to
the
sciatic
nerve
may
induce
also
sciatic
pain
,
but
without
neurological
disorder
.
So
then
the
treatment
is
to
remove
the
endometriosis
.
Now
if
you
have
endometriosis
of
the
sciatic
nerve
,
these
endometriosis
grow
within
the
sciatic
nerve
,
and
that
is
more
tricky
because
you
will
have
to
resect
the
endometriosis
out
of
the
sciatic
nerve
,
and
that
is
really
neurosurgery
.
So
normally
you
have
to
act
to
react
before
the
endometriosis
start
to
grow
within
the
sciatic
nerve
.
Speaker 1
3:12
You
would
want
someone
that's
specialized
with
endometriosis
and
neuropelviology
probably
to
address
that
right
.
That's
not
something
that
someone
common
could
probably
do
.
Speaker 2
3:22
No
,
definitely
to
say
I'm
a
high
specialist
in
endometriosis
,
or
endometriosis
of
the
sciatic
nerve
belong
to
my
gynecologist
panoply
.
No
,
endometriosis
of
the
sciatic
nerve
have
nothing
to
do
with
gynecological
surgery
,
except
the
name
endometriosis
.
But
that
is
really
a
moral
surgery
and
one
of
the
most
dangerous
and
most
difficult
procedures
within
the
pelvic
cavity
.
It's
not
just
for
gynecology
you
have
to
be
a
neuropulmonary
surgeon
,
and
at
least
level
three
with
a
lot
of
experience
.
Speaker 1
3:59
Wow
,
I
mean
because
that
could
impact
your
body
and
life
significantly
if
it's
not
done
right
yeah
.
Speaker 2
4:06
Yeah
,
the
problem
if
you
do
surgery
on
the
sciatic
nerve
and
you
are
not
trained
in
this
surgery
and
you
are
induced
unnecessary
damage
of
the
sciatic
nerve
,
patient
will
not
need
a
wheelchair
but
she
will
not
need
crutches
.
She
will
get
a
foot
drop
for
the
rest
of
your
life
.
So
it's
really
something
that
is
neurosurgery
.
It's
not
just
oh
,
I
suppose
you
have
suspicion
,
or
endometriosis
,
sciatic
nerve
,
let's
see
.
I
will
do
a
laparoscopy
.
I
learned
how
to
do
that
on
cadaver
dissection
.
I
will
go
there
and
I
will
check
.
No
,
you
have
to
have
a
clear
roadmap
and
a
clear
diagnosis
before
you
go
in
the
OR
.
Speaker 1
4:44
Yes
,
it's
the
mapping
aspect
of
endometriosis
knowing
before
you
get
in
.
Speaker 2
4:50
You
need
a
clear
neuropelviological
workup
before
you
indicate
any
surgery
on
the
pelvic
nerves
.
Speaker 1
4:59
That's
a
wrap
for
this
Quick
Connect
.
I
hope
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insights
helped
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