#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Meralgia paresthetica


Authors: R. Kaiser
Authors‘ workplace: Neurochirurgická a neuroonkologická klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenská nemocnice - Vojenská fakultní nemocnice Praha
Published in: Rozhl. Chir., 2018, roč. 97, č. 6, s. 286-290.
Category: Case Report

Overview

Meralgia paresthetica is a compression neuropathy of the lateral femoral cutaneous nerve. Despite its rarity, it is the most common nerve entrapment of the lower limbs. It produces similar symptoms as those associated with the more common L4 or L5 radiculopathy. Therefore, it is often diagnosed late (sometimes only after several years of latency) or not at all. This diagnosis should be considered especially in patients with obesity and diabetes who have chronic irritation of the ventrolateral areas of the thigh not responding to conservative therapy and a negative finding on lumbar MRI.

We present our experience with surgical nerve decompression in three patients with pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. They all suffered from severe abdominal obesity. All conservative treatments, including weight reduction attempts, were unsuccessful. Nerve release caused an immediate effect in two cases. One patient experienced a temporary worsening of pain, which gradually improved within one month.

In spite of the controversy surrounding the surgical treatment of meralgia (neurolysis or nerve resection), it can be concluded that nerve decompression has a good effect. Nerve resection is, in our view, considered to be a reserve option when primary surgery fails.

Key words:

meralgia paresthetica − nerve entrapment − peripheral nerve


Sources
  1. Bernhardt M. Ueber isolirt im Gebiet des N. cut. fem. ext. vorkommende Parästhesien. Neurol Centralb 1895;6:242.
  2. Roth RK. Meralgia parästhetica. Berlin, S Karger 1895.
  3. Weng WC, Wei YC, Huang WY, et al. Risk factor analysis for meralgia paresthetica: A hospital-based study in Taiwan. J Clin neurosci. 2017;43:192−5.
  4. Kaiser R, Haninec P. Operační léčba syndromu tarzálního tunelu. Cesk Slov Neurol N 2012;75:351−3.
  5. Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J sports phys ther 2013;8:883−93.
  6. Parisi TJ, Mandrekar J, Dyck PJ, et al. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology 2011;77:1538−42.
  7. Kaiser R. a kol. Chirurgie hlavových a periferních nervů s atlasem přístupů. Praha, Grada 2016.
  8. Fernandez-Mayoralas DM, Fernandez-Jaen A, Jareno NM, et al. Meralgia paresthetica in the pediatric population: a propos of 2 cases. J child neurol 2010;25:110−3.
  9. Tomaszewski KA, Popieluszko P, Henry BM, et al. The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis. Hernia 2016;20:649−57.
  10. Lee SH, Shin KJ, Gil YC, et al. Anatomy of the lateral femoral cutaneous nerve relevant to clinical findings in meralgia paresthetica. Muscle nerve 2017;55:646−50.
  11. Moritz T, Prosch H, Berzaczy D, et al. Common anatomical variation in patients with idiopathic meralgia paresthetica: a high resolution ultrasound case-control study. Pain phys 2013;16:E287−93
  12. Chhabra A, Del Grande F, Soldatos T, et al. Meralgia paresthetica: 3-Tesla magnetic resonance neurography. Skelet radiol 2013;42:803−8.
  13. Tagliafico A, Serafini G, Lacelli F, et al. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): technical description and results of treatment in 20 consecutive patients. J ultrasound med 2011;30:1341−6.
  14. Ahmed A, Arora D, Kochhar AK. Ultrasound-guided alcohol neurolysis of lateral femoral cutaneous nerve for intractable meralgia paresthetica: a case series. Brit j pain 2016;10:232−7.
  15. Aldrich EF, van den Heever CM. Suprainguinal ligament approach for surgical treatment of meralgia paresthetica. Technical note. J neurosurg 1989;70:492−4.
  16. Alberti O, Wickboldt J, Becker R. Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica. J neurosurg 2009;110:768−74
  17. Emamhadi M. Surgery for meralgia paresthetica: neurolysis versus nerve resection. Turk neurosurg 2012;22:758−62
  18. de Ruiter GC, Wurzer JA, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta neurochir 2012;154:1765−72
  19. Payne R, Seaman S, Sieg E, et al. Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica? Acta neurochir 2017;159:931−6.
Labels
Surgery Orthopaedics Trauma surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#