Neural endometriosis is an underestimated condition and a major challenge for surgeons due to the complexity of the anatomy and surgical techniques required and for radiologists because of the complexity of the neural anatomy in imaging methods. It is defined by the compression, infiltration, distortion, and irritation of epineural connective tissue with or without neural entrapment, caused by deep endometriosis (DE) or surrounding associated fibrosis. The diagnosis requires a complete and detailed anamnesis, a targeted neurological and vaginal examination, and using various imaging methods, of which magnetic resonance imaging (MRI) of the pelvis is the method of choice. The treatment of DE has improved greatly in recent decades, especially after the introduction of neurolysis laparoscopy and nerve-sparing techniques, positively impacting neural preservation. Imaging is important in this context because it can identify surgical risks, and a plan can be made to increase surgical security. Anticipating potential nervous injuries in advance changes the preoperative perspective for patients and surgeons, and it has a positive economic impact. A single procedure can be done, discussing it with the patient and pointing out the possible urinary, sexual, and anorectal dysfunctions. And for those with neural involvement, presurgical planning can be included, such as specific physiotherapy. Early diagnosis and multidisciplinary treatment are extremely important to minimize possible comorbidities.