Simultaneous laparoscopic and arthroscopic excision of a huge juxta-articular ganglionic cyst compressing the sciatic nerve: A case report.

Background: A large ganglionic cyst extending from the hip joint to the intrapelvic cavity through the sciatic notch is a rare space-occupying lesion associated with compressive lower-extremity neuropathy. A cyst in the pelvic cavity compressing the intrapelvic-sciatic nerve is easily missed in the diagnostic process because it usually presents as atypical symptoms of an extraperitoneal-intrapelvic tumor. We present a case of a huge ganglionic cyst that was successfully excised laparoscopically and endoscopically by a gynecologist and an orthopedic surgeon.

Case Summary: A 52-year-old woman visited our hospital complaining of pain and numbness in her left buttock while sitting. The pain began 3 years ago and worsened, while the numbness in the left lower extremity lasted 1 mo. She was diagnosed and unsuccessfully treated at several tertiary referral centers many years ago. Magnetic resonance imaging revealed a suspected paralabral cyst (5 cm × 5 cm × 4.6 cm) in the left hip joint, extending to the pelvic cavity through the greater sciatic notch. The CA-125 and CA19-9 tumor marker levels were within normal limits. However, the cyst was compressing the sciatic nerve. Accordingly, endoscopic and laparoscopic neural decompression and mass excision were performed simultaneously. A laparoscopic examination revealed a tennis-ball-sized cyst filled with gelatinous liquid, stretching deep into the hip joint. An excisional biopsy performed in the pelvic cavity and deep gluteal space confirmed the accumulation of ganglionic cysts from the hip joint into the extrapelvic intraperitoneal cavity.

Conclusion: Intra- or extra- sciatic nerve-compressing lesion should be considered in cases of sitting pain radiating down the ipsilateral lower extremity. This large juxta-articular ganglionic cyst was successfully treated simultaneously using laparoscopy and arthroscopy.