Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica.
OBJECTIVE
Neurosurgical textbooks describe an infrainguinal approach as the standard or preferred option for the surgical treatment of meralgia paresthetica (MP), the most frequent entrapment neuropathy of the lower limb. However, inhomogeneous results led the authors to adopt a suprainguinal, retroperitoneal approach for decompression of the lateral femoral cutaneous nerve. In this paper the authors' aim was to study the outcome of patients harboring MP treated via this different surgical approach.


METHODS
The outcome of 55 consecutive patients who underwent surgery for MP via the suprainguinal retroperitoneal approach during a 15-year period was ascertained through postal questionnaires (in 47 patients) and follow-up visits (in 8 patients). The male to female ratio was 1:0.67, and the mean patient age was 50 +/- 12.9 years. The mean follow-up was 3.2 +/- 3.3 years. Seven of the patients underwent bilateral surgery.


RESULTS
Intraoperatively the lateral femoral cutaneous nerve was consistently found in close anatomical relationship to the anterior superior iliac spine, although some variations regarding the diameter, number of branches, and underlying pathological entity were observed. Eighty-seven percent of patients showed improvement (21 patients) or complete remission (27 patients) of painful dysesthesia in the anterolateral thigh, and 13% (7 patients) remained unchanged. In addition 82% had improvement (31 patients) or complete remission (14 patients) of hypesthesia, leaving 18% with unchanged (9 patients) or worsened (1 patient) hypesthesia. In the patient-evaluated group 66% (31 of 47) were completely satisfied with the outcome, 23% (11 of 47) were partially satisfied, and 11% (5 of 47) were not satisfied with the outcome. Two cases each of recurrence, seroma, wound infection, and 1 case of hematoma requiring revision were encountered as complications.


CONCLUSIONS
The suprainguinal retroperitoneal approach is a viable first-choice option for the surgical relief of MP.
Alberti
Olaf
O
Department of Neurosurgery, Asklepios Kliniken Schildautal, Seesen, Germany. o.alberti@asklepios.com
Wickboldt
Jürgen
J
Becker
Ralf
R
D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007264:Inguinal Canal; D007866:Leg / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome