---
title: Sciatic Nerve Endometriosis
description: Neuropelveology, founded by Prof. Possover, treats pelvic nerve disorders like chronic pain, endometriosis, and spinal injuries using LANN and LION surgical techniques.
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# Online Blog: More knowledge for patients

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# Sciatic Nerve Endometriosis

Marc Possover,

October 1, 2024

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Prof. Prof. DK Prof. Dr. med. Marc Possover, MD, PhD

## **Endometriosis of the Sciatic Nerve**

##### **Why This Is *Not* a Gynecological Disease, and Why Neuropelveology Is the Only Correct Diagnostic and Surgical Approach**

Endometriosis is traditionally considered a gynecological disease.  
When endometriosis involves the uterus, ovaries, or pelvic peritoneum, this is correct.

However, **endometriosis of the sciatic nerve is not a gynecological disease.**  
It is a *neurological disease occurring inside the pelvis*.

And this distinction changes everything.

 

**A Disease of the Nervous System - Not of the Uterus**

The sciatic nerve is the largest nerve in the human body.  
When endometriotic tissue infiltrates this nerve, the disease affects:

- nerve conduction  
  • sensory and motor pathways  
  • autonomic pelvic control  
  • gait, muscle strength, and reflexes

This is not a disorder of reproductive organs, it is a primary pelvic neuropathy caused by endometriotic nerve infiltration.Therefore, the diagnosis belongs to neurology, and the surgery belongs to neurosurgery - *not to classical gynecology.*

 

**Why Classical Neurology Cannot Diagnose Pelvic Nerve Disease**

Here lies the paradox:

Pelvic nerves are deep intrapelvic structures, that cannot be examined with standard neurological testing. The only reliable clinical examination of pelvic nerves is:

- transvaginal nerve palpation  
  • transrectal nerve palpation

These examinations are gynecological by access, but neurological by nature**. **They are completely outside the training, legal scope, and ethical framework of classical neurology. A neurologist cannot perform intravaginal pelvic nerve palpation. This would be unthinkable and unacceptable.

As a result, pelvic nerve diseases were historically “invisible” to neurology.

They simply had no diagnostic doorway.

 

**Why Classical Gynecology Cannot Treat Pelvic Nerve Disease**

Gynecologists are trained in:

- genital organs and retroperitoneal surgery  
  • pelvic oncology  
  • peritoneal endometriosis  
  • fertility preservation

They are not trained in nerve diagnostic and not trained in neuro-surgical nerve procedure and reconstruction. Being able to expose a nerve laparoscopically does **not** make someone a neurosurgeon. Pelvic nerve surgery requires:

- neuroanatomical mapping  
  • neurofunctional preservation  
  • microsurgical nerve decompression  
  • intraneural dissection techniques  
  • regeneration-oriented nerve handling
- expertise in neurofunctional surgery and neuromodulation

This is **neuro-surgery - not gynecological surgery.**

 

**Neuropelveology: The Missing Discipline**

Neuropelveology was created precisely to solve this paradox.

It is the discipline that:

- performs neurological diagnosis adapted to pelvic nerves  
  • uses gynecological access routes (vaginal, rectal, laparoscopic)  
  • applies neurosurgical principles to pelvic nerve surgery  
  • reconstructs pelvic neural pathways  
  • treats pelvic neuropathies at their true origin

**Sciatic nerve endometriosis is a neuropelveological disease.**

Its diagnosis is neurological.  
Its surgery is neurosurgical.  
Its access is gynecological.  
Its discipline is Neuropelveology.

 

**A Dangerous Trend: “Social-Media Neuropelveology”**

In recent years, a growing number of surgeons have begun to present themselves online as “specialists in sciatic nerve endometriosis surgery” — without:

- formal neuropelveological training  
  • neurological diagnostic competence  
  • neurosurgical nerve education  
  • scientific outcome publications  
  • peer-reviewed evidence  
  • certified expertise

Self-declaration on social media is not qualification.

Pelvic nerve surgery without neurological diagnosis is blind surgery.

Blind nerve surgery causes permanent neurological damage.

 

**What Patients Must Demand**

Patients suffering from sciatic pain, foot drop, pelvic neuralgia or unexplained neurological symptoms must demand:

- documented neuropelveological diagnosis  
  • peer-reviewed scientific publications  
  • certified training in pelvic nerve surgery  
  • verifiable surgical outcome data

Not Instagram expertise.  
Not self-proclaimed titles.  
But **science, certification, and proof.**

 

**Conclusion**

Sciatic nerve endometriosis is not “deep endometriosis.”

It is **pelvic nerve disease caused by endometriotic nerve infiltration.**

It belongs to **neurology by pathology, neurosurgery by treatment, and Neuropelveology by reality.**

And it can only be treated safely by those trained in all three.

 

#### **References**

1. Possover M. Laparoscopic morphological aspects and tentative of explanation the etiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients. Facts Views Vis Obgyn, 2021;13(4): 331-337
2. Possover M. Laparoscopic management of isolated infiltrating endometriosis of the sciatic nerve. Video-article, Journal of Minimally Invasive Gynecology 2020.
3. Possover M. Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis. J Minim Invasive Gynecol. 2017 Jul - Aug;24(5):822-826.
4. Possover M. Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltration rectovaginal and/or parametric endometriosis. Fertil Steril 2014; 101:754-8
5. Possover M. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 2021; 95(2): 756-8.
6. Possover M. Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. Minim Invasive Neurosurg 2007; 50: 33-36.
7. Possover M, Chiantera V. Isolated infiltrative endometriosis of the sciatic nerve: about three cases. Fertil Steril 2007; 87: 417-9.
8. Possover M, Kerstin Rhiem, Vito Chiantera. The “neurologic hypothesis: a new concept in the pathogenesis of the endometriosis? Gynecolog Surge 2005; (2): 107-111.
9. Possover M. Vorgehen bei der ausgedehnten retroperitonealen Endometriose. Gyn Praktische Gynäkologie, 2003, 2:110-124.
10. Possover M, Mallmann P. Follow-up of patients after laparoscopic vaginal resection of the endometriosis of the rectovaginal septum with colorectal anastomosis. Journal of Pelvic Surgery 2002,8: 83-88.
11. Possover M, Diebolder H, Plaul K, Schneider A. Laparoscopic-assisted vaginal resection of recto-vaginal endometriosis. Obstetrics and Gynecology, 2000; 96, 304-307.
12. Possover M, Diebolder H, Stöber S, Schneider A. Laparoskopisch assistierte vaginale Resektion der Endometriose. Ambulant Operieren 1999; 2: 46-50.

— Prof. Marc Possover  
Founder of Neuropelveology

 

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If you or someone you know is struggling with **chronic pelvic pain, pelvic nerve disorders, endometriosis, or consequences of pelvic surgery**, please contact us via email at **international@possover.com** to begin the process. Because we want to avoid the scenario where a patient travels to Zurich, only to discover that we may not be able to offer help for their specific situation, we have **Pre-Consultation Zoom process**. **How does it work?**

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