A Rare Variation of High Division of the Sciatic Nerve and Associated Neuromuscular Variations in the Gluteal Region.

Variations in the anatomical division of the sciatic nerve are not uncommon. In this case report, we are presenting a rare variation of the sciatic nerve in relation to the superior gemellus and the presence of anomalous muscle. To the best of our knowledge, the anomalous communicating branches of the posterior cutaneous femoral nerve with tibial and common peroneal nerve and the presence of an anomalous muscle originating from the greater sciatic notch and inserting at ischial tuberosity have not been reported yet in the literature. This anomalous muscle found can be named as 'Sciaticotuberosus' after its origin and insertion. Such variations hold clinical significance as they may contribute to piriformis syndrome, coccydynia, non-discogenic sciatica, and popliteal fossa block failure leading to local anesthesia toxicity and blood vessel traumatization. The current classifications of division of the sciatic nerve are based on its relation to the piriformis muscle. In our case report, the variation of the sciatic nerve in relation to the superior gemellus suggests the need for the revision of current classification systems. Category-like division of the sciatic nerve in relation to the superior gemellus muscle can be added.