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Chronic meralgia paresthetica and neurectomy: a clinical pathologic study.

Sarah E Berini1, Robert J Spinner, Mark E Jentoft

  • 1From the Peripheral Neuropathy Research Laboratory (S.E.B., J.K.E., N.P.S., N.S., P.J.B.D., C.J.K.), the Department of Neurosurgery (R.J.S.), and the Department of Anatomic Pathology (M.E.J.), Mayo Clinic and Mayo Foundation, Rochester, MN.

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Chronic meralgia paresthetica (MP) involves lateral femoral cutaneous nerve (LFCN) damage. Neurectomy for severe MP pain, often linked to inguinal ligament compression, provided significant relief in most patients.

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Area of Science:

  • Neurology
  • Pathology
  • Surgical Science

Background:

  • Meralgia paresthetica (MP) is a condition characterized by pain and numbness in the lateral thigh.
  • Chronic MP can lead to intractable pain, significantly impacting quality of life.
  • Lateral femoral cutaneous nerve (LFCN) neurectomy is a surgical option for refractory MP.

Purpose of the Study:

  • To investigate the pathological and clinical characteristics of patients with chronic meralgia paresthetica (MP) who underwent lateral femoral cutaneous nerve (LFCN) neurectomy.
  • To correlate clinical findings with pathological nerve changes in MP patients.
  • To evaluate the efficacy of LFCN neurectomy in managing intractable MP pain.

Main Methods:

  • Retrospective cohort study of 7 patients undergoing LFCN neurectomy for intractable MP.
  • Review of clinical, radiological, and electrophysiological data.
  • Analysis of gross pathology and histopathology of resected LFCN, compared to control specimens.

Main Results:

  • Patients presented with severe, long-standing lateral thigh pain and numbness, often associated with obesity.
  • Intraoperative and pathological findings revealed focal nerve indentation at the inguinal ligament in most cases.
  • Histopathology showed nerve fiber loss, selective large myelinated fiber loss, perineurial thickening, and inflammation. Six of seven patients reported significant pain improvement post-neurectomy.

Conclusions:

  • Chronic MP with intractable pain is characterized by LFCN mononeuropathy, likely due to compressive pathogenesis at the inguinal ligament.
  • Nerve inflammation may contribute to the condition's pathogenesis.
  • LFCN neurectomy is an effective treatment for selected patients with chronic MP, particularly those with inguinal ligament compression.