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Published in: Acta Neurochirurgica 2/2019

01-02-2019 | Original Article - Peripheral Nerves

Histopathologic changes inside the lateral femoral cutaneous nerve obtained from patients with persistent symptoms of meralgia paresthetica

Authors: Godard C. W. de Ruiter, Joann Lim, Bregje J. W. Thomassen, Sjoerd G. van Duinen

Published in: Acta Neurochirurgica | Issue 2/2019

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Abstract

Background

In patients with persistent symptoms of meralgia paresthetica, a neurectomy of the lateral femoral cutaneous nerve (LFCN) can be performed to alleviate pain symptoms. The neurectomy procedure can be performed either as a primary procedure or after failure of a previously performed neurolysis or decompression of the LFNC (secondary neurectomy). The goal of the present study was to quantify the histopathologic changes inside the LFCN obtained from patients with persistent symptoms of meralgia paresthetica, and specifically to compare to what extend these changes are present after primary versus secondary neurectomy.

Methods

A total of 39 consecutive cases were analyzed microscopically: in 29 cases, the neurectomy had been performed as primary procedure, in 10 cases, after failed neurolysis. Intraneural changes were quantified for the (1) thickening of perineurium, (2) deposition of mucoid, and (3) percentage of collagen. Analysis was performed at three levels: proximal to, at, and distal to the previous site of compression. In addition, correlations were investigated for the duration of symptoms and the body mass index (BMI) of the patient.

Results

Intraneural changes were found consistently in all cases. There was no significant difference for the primary and secondary neurectomy groups. There was also no relation with the previous site of compression. There was a weak correlation between the occurrence of intraneural changes and the duration of symptoms, although this difference was not statistically significant.

Conclusions

Histopathological changes in this study were found in all patients with persistent symptoms of meralgia paresthetica regardless of a previously performed neurolysis procedure. This finding suggests that the intraneural changes that occur in persistent meralgia paresthetica are largely irreversible and support the surgical strategy of neurectomy as an alternative to neurolysis, also for primary surgical treatment and not only after failure of neurolysis.
Footnotes
1
We are currently investigating the effectiveness of the neurolysis and neurectomy procedures in a randomized controlled trial, named the STOMP trial (Surgical Treatment Options for Meralgia Paresthetica).
 
Literature
1.
go back to reference Aszmann OC, Dellon ES, Dellon AL (1997) Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 100:600–604CrossRefPubMed Aszmann OC, Dellon ES, Dellon AL (1997) Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 100:600–604CrossRefPubMed
10.
go back to reference Schwaiger K, Panzenbeck P, Purschke M, Russe E, Kaplan R, Heinrich K, Mandal P, Wechselberger G (2018) Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for meralgia paresthetica treatment: experimental or state of the art? A single-center outcome analysis. Medicine (Baltimore) 97:e11914. https://doi.org/10.1097/MD.0000000000011914 CrossRef Schwaiger K, Panzenbeck P, Purschke M, Russe E, Kaplan R, Heinrich K, Mandal P, Wechselberger G (2018) Surgical decompression of the lateral femoral cutaneous nerve (LFCN) for meralgia paresthetica treatment: experimental or state of the art? A single-center outcome analysis. Medicine (Baltimore) 97:e11914. https://​doi.​org/​10.​1097/​MD.​0000000000011914​ CrossRef
Metadata
Title
Histopathologic changes inside the lateral femoral cutaneous nerve obtained from patients with persistent symptoms of meralgia paresthetica
Authors
Godard C. W. de Ruiter
Joann Lim
Bregje J. W. Thomassen
Sjoerd G. van Duinen
Publication date
01-02-2019
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 2/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-018-3773-8

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