J Korean Neurosurg Soc.  2012 Jun;51(6):363-366. 10.3340/jkns.2012.51.6.363.

Neurolysis for Megalgia Paresthetica

• Son BC
• Kim DR
• Kim IS
• Hong JT
• Sung JH
• Lee SW

• KMID: 2190491
• DOI: http://doi.org/10.3340/jkns.2012.51.6.363

Abstract

OBJECTIVE
Meralgia paresthetica (MP) is a syndrome of pain and/or dysesthesia in the anterolateral thigh that is caused by an entrapment of the lateral femoral cutaneous nerve (LFCN) at its pelvic exit. Despite early accounts of MP, there is still no consensus concerning the effectiveness of neurolysis or transaction treatments in the long-term relief for medically refractory patients with MP. We retrospectively analyzed available long-term results of LFCN neurolysis for medically refractory MP in an effort to clarify this issue.
METHODS
During the last 7 years, 11 patients who had neurolysis for MP were enrolled in this study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic injection. Decompression of the LFCN was performed at the level of the iliac fascia, inguinal ligament, and fascia of the thigh distally. The outcome of surgery was assessed 8 weeks after the procedure followed at regular intervals if symptoms persisted.
RESULTS
Twelve decompression procedures were performed in 11 patients over a 7-year period. The average duration of symptoms was 8.5 months (range, 4-15 months). The average follow-up period was 33 months (range, 12-60 months). Complete and partial symptom improvement were noted in nine (81.8%) and two (18.2%) cases, respectively. No recurrence was reported.
CONCLUSION
Neurolysis of the LFCN can provide adequate pain relief with minimal complications for medically refractory MP. To achieve a good outcome in neurolysis for MP, an accurate diagnosis with careful examination and repeated blocks of the LFCN, along with electrodiagnosis seems to be essential. Possible variation in the course of the LFCN and thorough decompression along the course of the LFCN should be kept in mind in planning decompression surgery for MP.

Keyword

Entrapment neuropathy; Lateral femoral cutaneous nerve; Meralgia paresthetica; Neurolysis

MeSH Terms

Consensus
Decompression
Electrodiagnosis
Fascia
Follow-Up Studies
Humans
Ligaments
Nerve Compression Syndromes
Paresthesia
Recurrence
Retrospective Studies
Thigh
Nerve Compression Syndromes

Figure

• 

  Fig. 1 Operative findings of decompression with neurolysis. A : A clinical photo showing the maximal painful dysesthetic area of right lateral theigh. B : Initial exposure of the course of lateral femoral cutaneous nerve. Note two branches, anterior and posterior branches of lateral femoral cutaneous nerve. C : Final operative photograph showing complete decompression along the course of lateral femoral cutaneous nerve. Decompression of the nerve was performed at the level of the iliac fascia, the inguinal ligament, and the fascia of the thigh distally.

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