Venous malformation as a rare cause of sciatic neuropathy

Sciatic neuropathy is rare and difficult to diagnose in pediatrics and often associated with difficult to control neuropathic pain. The most common causes of sciatic nerve damage in children include trauma and iatrogenic lesions, less often the cause is tumor and vascular formations, among which intraneural venous malformations are the rarest. We present a clinical case of a 13-year boy suffered from right sciatic pain neuropathy with unexpressed neuropathic pain syndrome, asymmetry of the feet, scant impairment of motor and sensory function of the limb for five years, which changed the  gait. Neurophysiological testing showed possible location of the process, an asymmetry of sensory and motor responses when testing the nerves of the legs, and abnormal EMG in sciatic-innervated muscles. The magnetic resonance imaging (MRI) showed focal enlargement of the right sciatic nerve in the pelvic region with enhancement upon administration of contrast. Due to the presence of pain in the limb and its forced position — bent at the knee joint, surgical treatment — endoneural neurolysis in combination with targeted therapy by immunosuppressant, was chosen as a therapeutic strategy. The histological study of the intraneural formation confirmed the presence of a venous malformation (VM) in the form of heterogeneous thick– and thin-walled vascular cavities by the presence of fibrosis and lymphocytic infiltration. The result of the treatment was the relief of neuropathic pain syndrome and the recovering of the child gait.

Compliance with ethical standards. Voluntary informed consent was obtained from the patient’s legal representative for treatment and publication of data.

Contribution:
Druzhinina E.S. — review of publications on the topic of the article, collection and analysis of data, writing the text of the manuscript;
Isaev I.V. — performing a surgical intervention, writing the text of an article;
Kostylev F.A. — data collection, writing the text of article;
Narbutov A.G. — performing a surgical intervention, writing the text of an article;
Zavadenko N.N. — writing the text of the article, checking critical intellectual content, final approval for publication of the manuscript.
All co-authors are responsible for the  integrity of all parts of the manuscript and approval of its final version.

Acknowledgements. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: March 13, 2023
Accepted:  March 27, 2023
Published: October 13, 2023

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