Anatomical considerations on transposition of the lateral femoral cutaneous nerve

Ruiter, Godard C.W. de; Kloet, Fred

doi:10.1002/ca.23057

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…In addition to neurectomy, several strategies have been suggested for decompression, including simple decompression, combination of superficial and deep decompressions, decompression with the iliac fascia incision, and medial transposition. 5,6,[9][10][11]15 To date, there is no consensus as to what is being decompressed in actuality. 5,10 The lack of understanding of the precise anatomy of the fascial configuration around the nerve appears to be part of the current debate on the optimal management strategy.…”

Section: Theoretical Surgical Strategy For Lfcn Decompressionmentioning

confidence: 99%

“…5,6,[9][10][11]15 To date, there is no consensus as to what is being decompressed in actuality. 5,10 The lack of understanding of the precise anatomy of the fascial configuration around the nerve appears to be part of the current debate on the optimal management strategy. 9 The present study precisely defined that the internal oblique-iliac fascia septum and iliolata ligaments were 2 major anatomical structures that may make the LFCN susceptible to mechanical entrapment near the ASIS.…”

Section: Theoretical Surgical Strategy For Lfcn Decompressionmentioning

confidence: 99%

“…For example, at the level of the inguinal ligament, increasing evidence has shown that the patients experienced better results when deep decompression with cutting the fascia underlying the nerve is added to superficial decompression. 5,9,18,23 At the level of the iliolata ligaments, clinical improvement was observed even in patients with surgery for MP where no LFCN was found, 3 suggesting that the nerve may have been decompressed by surgical "blind" dissection of the iliolata ligaments.…”

Section: Limitationsmentioning

confidence: 99%

“…A number of surgical treatments for MP have been employed, including simple decompression, a combination of superficial and deep decompressions, decompression with iliac fascia incision, medial transposition, and 360° decompression, 1,5,6,[9][10][11]15 and some of them have provided very good results, with success rates ranging from 93% to 100%. 18,23,24 However, the efficacy and underlying mechanism of individual surgical techniques remain to be pinpointed, mainly because of lack of understanding of the anatomy of the fascial planes around the LFCN.…”

mentioning

confidence: 99%

“…18,23,24 However, the efficacy and underlying mechanism of individual surgical techniques remain to be pinpointed, mainly because of lack of understanding of the anatomy of the fascial planes around the LFCN. 5,6,[9][10][11] Technically, the study of the fascial architecture is complicated by the fact that great difficulties exist in dissecting out delicate structures. Although histological examination may be able to overcome the problem, the application of such a method is greatly limited by the size of sample areas, alteration of tissue architecture during decalcification, and difficulty in tracing the origin of a fibrous structure.…”

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confidence: 99%

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Fine architecture of the fascial planes around the lateral femoral cutaneous nerve at its pelvic exit: an epoxy sheet plastination and confocal microscopy study

Xu¹,

Tu²,

Zheng

et al. 2019

Journal of Neurosurgery

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OBJECTIVEMeralgia paresthetica is commonly caused by mechanical entrapment of the lateral femoral cutaneous nerve (LFCN). The entrapment often occurs at the site where the nerve exits the pelvis. Its optimal surgical management remains to be established, partly because the fine architecture of the fascial planes around the LFCN has not been elucidated. The aim of this study was to define the fascial configuration around the LFCN at its pelvic exit.METHODSThirty-six cadavers (18 female, 18 male; age range 38–97 years) were used for dissection (57 sides of 30 cadavers) and sheet plastination and confocal microscopy (2 transverse and 4 sagittal sets of slices from 6 cadavers). Thirty-four healthy volunteers (19 female, 15 male; age range 20–62 years) were examined with ultrasonography.RESULTSThe LFCN exited the pelvis via a tendinous canal within the internal oblique–iliac fascia septum and then ran in an adipose compartment between the sartorius and iliolata ligaments inferior to the anterior superior iliac spine (ASIS). The iliolata ligaments newly defined and termed in this study were 2–3 curtain strip–like structures which attached to the ASIS superiorly, were interwoven with the fascia lata inferomedially, and continued laterally as skin ligaments anchoring to the skin. Between the sartorius and tensor fasciae latae, the LFCN ran in a longitudinal ligamental canal bordered by the iliolata ligaments.CONCLUSIONSThis study demonstrated that 1) the pelvic exit of the LFCN is within the internal oblique aponeurosis and 2) the iliolata ligaments form the part of the fascia lata over the LFCN and upper sartorius. These results indicate that the internal oblique–iliac fascia septum and iliolata ligaments may make the LFCN susceptible to mechanical entrapment near the ASIS. To surgically decompress the LFCN, it may be necessary to incise the oblique aponeurosis and iliac fascia medial to the LFCN tendinous canal and to free the iliolata ligaments from the ASIS.

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Section: Theoretical Surgical Strategy For Lfcn Decompressionmentioning

confidence: 99%

Section: Theoretical Surgical Strategy For Lfcn Decompressionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Fine architecture of the fascial planes around the lateral femoral cutaneous nerve at its pelvic exit: an epoxy sheet plastination and confocal microscopy study

Xu¹,

Tu²,

Zheng

et al. 2019

Journal of Neurosurgery

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

et al. 2018

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Dynamic decompression of the lateral femoral cutaneous nerve to treat meralgia paresthetica: technique and results

Malessy

Eekhof

Pondaag

2019

Journal of Neurosurgery

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OBJECTIVEThe results of lateral femoral cutaneous nerve (LFCN) decompression to treat idiopathic meralgia paresthetica (iMP) vary widely. Techniques to decompress the LFCN differ, which may affect outcome, but in MP it is unknown to what extent. The authors present a new technique using dynamic decompression and discuss the outcomes.METHODSA retrospective cohort study was performed in a consecutive series of 19 cases. The goal of decompression was pain relief and recovery of sensation. The plane ventral to the LFCN was decompressed by cutting the fascia lata and the inferior aspect of the inguinal ligament. The plane dorsal to the LFCN was decompressed by cutting the fascia of the sartorius muscle. Subsequently, the thigh was brought in full range of flexion and extension/abduction. The authors identified and additionally cut fibers that tightened and caused compression at various locations of the LFCN during movement in all patients, referring to this technique as dynamic decompression. Postoperatively, an independent neurologist scored pain and sensation on a 4-point scale: completely resolved, improved, not changed, or worsened. Patients scored their remaining pain or sensory deficit as a percentage of the preoperative level. Statistical assessment was done using ANOVA to assess the association between outcome and duration of preoperative symptoms, BMI, and length of follow-up.RESULTSIn 17 of the 19 cases (89%), the pain and/or paresthesia completely resolved. Patients in the remaining 2 cases (11%) experienced 70% and 80% reduction in pain. Sensation completely recovered in 13 of the 19 cases (69%). In 5 of the 19 cases (26%) sensation improved, but an area of hypesthesia remained. Four of these 5 patients indicated a sensory improvement of more than 75%, and the remaining patient had 50% improvement. Sensation remained unchanged in 1 case (5%) with persisting hypesthesia and mild hyperesthesia. There was no significant impact of preoperative symptom duration, BMI, and length of follow-up on postoperative outcome.CONCLUSIONSDynamic decompression of the LFCN is an effective technique for the treatment of iMP. Most patients become completely pain free and sensation recovers considerably.

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Anatomical considerations on transposition of the lateral femoral cutaneous nerve

Cited by 3 publications

References 8 publications

Fine architecture of the fascial planes around the lateral femoral cutaneous nerve at its pelvic exit: an epoxy sheet plastination and confocal microscopy study

Fine architecture of the fascial planes around the lateral femoral cutaneous nerve at its pelvic exit: an epoxy sheet plastination and confocal microscopy study

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

Dynamic decompression of the lateral femoral cutaneous nerve to treat meralgia paresthetica: technique and results

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