The discipline of Neuropelveology, founded by Prof. Possover, offers new diagnostic and therapeutic possibilities in the treatment of chronic unexplained pelvic pain and functional disorders. One of these therapy options relates to deep infiltrating endometriosis of the sciatic nerve¹. In this particular clinical form of pelvic neuropathy, the endometrium attaches itself directly to the sciatic nerve, which can lead to painful burning symptoms in the pelvic area, the legs and feet as well as to functional deficits of the feet in the women affected - cyclically at first, and continuously after only a few short months. If the disease is not treated, endometriosis gradually destroys the sciatic nerve and the neurological deficits, such as the loss of dorsal and plantar flexion of the foot, become irreversible.
A prerequisite for etiological treatment is that the endometriosis of the sciatic nerve is recognised at all. Most patients tend to consult a neurologist, a back specialist (neurosurgeon, orthopaedic surgeon) or a pain therapist because the typical symptoms of the disease do not show the characteristics associated with gynaecological pain. Gynaecologists who are not familiar with endometriosis of the sciatic nerve will frequently refer patients with such symptoms to a specialist.
In endometriosis of the sciatic nerve, the symptoms are caused by the sciatic nerve (ischiadic nerve). Since the pain occurs in the supply area of the sciatic nerve, it is an ischialgia, also called sciatic syndrome. About 15 years ago, Prof. Possover drew the attention of medical experts to this disease. However, this type of neuralgia is usually attributed to orthopaedic or neurosurgical aetiologies, such as herniated discs in the lumbar or sacral vertebrae, inflammations, facet syndrome, stenosis of the foraminae, etc. The disease is also known as "stenosis". If no orthopaedic or neurosurgical cause can be determined, this pain syndrome is referred to as "sciatica of unclear genesis". It is rarely considered by medical specialists that damage to the sciatic nerve, which runs through the pelvis between the spinal cord and the legs, can lead to just this type of "sciatica of unclear genesis".
By contrast, doctors who study Neuropelveology and learn the diagnostic and treatment procedures that are based on this young medical discipline can quickly determine whether the patient is suffering from endometriosis of the sciatic nerve. Laparoscopy is used for confirmation. Through laparoscopic exploration of the pelvic nerves, irritations, compressions, injuries or tumours of the pelvic nerves can be detected and treated. The therapy is based on the adaptation of neurosurgical procedures to the pelvic nerves by laparoscopy². More on neuropelveological diagnosis and treatment of endometriosis of the sciatic nerve and sacral roots.
The only way to safely remove endometriosis from the sciatic nerve is with laparoscopic surgery. The use of tiny cameras enables minimally invasive, high precision treatment with the best possible preservation of the nerves. Hormone therapy is not effective and carries the risk of unnecessarily delaying the surgical treatment of the disease. However, surgery is absolutely essential in order to avoid irreversible damage to the nerves and the associated motor deficits.
At the Endometriosis Center Zurich in Switzerland - part of the Possover International Medical Center - Prof. Possover has already performed more than 350 operations to remove endometriosis from the sciatic nerve. He is thus the world's leading expert in the laparoscopic treatment of endometriosis of the sciatic nerve. The Zürich Endometriosis Center offers patients individual advice and therapies based on the latest medical and scientific research. It has been tested by international experts and was the first centre in Switzerland to be certified as a Level III Endometriosis Centre by the "Endometriosis Research Foundation" and the "European Endometriosis League". The Possover International Medical Center is also the world's first competence center for Neuropelveology. The focus is on pioneering methods of specialised pelvic surgery.
Based on his many years of experience in both primary research and clinical trials in the field of endometriosis, with a focus on deep infiltrating endometriosis, Prof. Possover has also advanced the diagnosis and surgical treatment of the pelvic nerves using abdominal surgery. Thanks to high-resolution video cameras and a special magnification, laparoscopy, which has been specially developed for use on the pelvic nerves, enables nerve-sparing surgery on the sciatic nerve and all other pelvic nerves. The laparoscopic accessibility of all pelvic nerves allows the functions of the bladder, intestine and sexual organs to be maintained.
The removal of endometriosis of the sciatic nerve is the most demanding of all pelvic surgeries. It requires the surgeon to have a profound knowledge of the anatomical complexity of the pelvis - especially the pelvic nerves - and extensive surgical experience. In order to strengthen these competencies and establish them worldwide, Prof. Possover passes on his knowledge in the discipline of Neuropelveology and the know-how necessary for the diagnosis and treatment of diseases of the pelvic nerves to colleagues all over the world.
Prof. Possover has founded The International School of Neuropelveology ( ISNP ) and created an e-learning platform to provide physicians with access to convenient continuing education in the field of Neuropelveology. His motivation results from the desire to give affected patients worldwide access to the new treatment methods he has developed. The learning modules also contain the knowledge that enables a physician to reliably diagnose endometriosis of the sciatic nerve and thus open the way to causal treatment for the affected patients. The learning content and workshops are aimed at gynaecologists, surgeons and urologists as well as general physicians and pain therapists worldwide.
The introductory training videos are available free of charge. They give you a first impression of the eLearning course Neuropelveology ISON Level 1. You have access to first-hand theory and practical experience and can learn online conveniently, at any time and from anywhere. Prof. Possover also presents his knowledge at live events and congresses. Here you will find the dates of the upcoming events. https://isnp.possover.com
With your professional training in Neuropelveology, you will also contribute to advancing the as yet largely unknown field of pathology of the pelvic nerves, especially the somatic pelvic nerves, in medical practice. You can offer many despairing patients the chance to return to a better quality of life and lead a virtually pain-free existence.
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¹ Possover M, Schneider T, Henle KP. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertile Sterile. 2011 Feb;95(2):756-758
² Possover M. New surgical evolutions in management of sacral radiculopathies. Surg Technol Int 2010;19: 123-128
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