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Type II sciatic nerve variant: an unexpected interventional hazard.

Graeme Thompson1, Ruan Visagie2

  • 1Morton and Partners Radiologists, Cape Town, South Africa. graeme.thompson@morton.co.za.

Skeletal Radiology
|July 28, 2017
PubMed
Summary
This summary is machine-generated.

A pediatric osteoid osteoma removal led to unexpected sciatic nerve injury due to an anatomical variant. Pre-procedural imaging is crucial for identifying such variations to prevent complications during pelvic interventions.

Keywords:
AcetabulumIatrogenicInjuryOsteoid osteomaPiriformisSciatic nerveType II variant

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Neuroanatomy

Background:

  • Osteoid osteomas are benign bone tumors often requiring surgical intervention.
  • Pelvic interventions carry risks due to proximity to neurovascular structures.
  • Anatomical variations can complicate surgical planning and execution.

Observation:

  • A 12-year-old girl with hip pain was diagnosed with an acetabular osteoid osteoma.
  • Percutaneous CT-guided drilling was performed for lesion removal.
  • Post-operatively, MRI revealed common peroneal nerve injury with muscle denervation.

Findings:

  • The injury was attributed to an unusual sciatic nerve variant with the common peroneal nerve exiting superolaterally.
  • This variant positioned the nerve adjacent to the planned guidewire trajectory.
  • Histology confirmed the osteoid osteoma, but the nerve injury was a procedural complication.

Implications:

  • Highlights the critical need for pre-procedural identification of sciatic nerve variants in pelvic interventions.
  • Emphasizes the importance of detailed anatomical review to mitigate risks of iatrogenic nerve injury.
  • Suggests enhanced imaging protocols may be beneficial for complex pelvic procedures in pediatric patients.