De plaats van chirurgie in de behandeling van meralgia paresthetica

Decompression of the lateral femoral cutaneous nerve: indications and outcomes Introduction: Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), which is a purely sensory nerve innervating the anterolateral thigh. Although the condition is generally mild and self-limiting, treatment can be challenging in patients experiencing debilitating and refractory pain. The efficacy and safety of neurolysis of the LFCN remain subjects of ongoing debate. Methodology: A literature review was performed to provide an overview of the various treatment options for MP. Furthermore, a retrospective analysis was conducted on all patients with refractory MP who underwent neurolysis at the Neurosurgical Center North-West Flanders (Belgium) between 2021 and July 2024 to evaluate the safety and efficacy of the procedure. The primary outcome measure was the percentage of pain reduction compared to the preoperative state, assessed 4–6 weeks postoperatively. The secondary outcome measure was the incidence of complications. Results: Conservative therapies, such as weight loss and avoidance of provocative activities and local compresion, combined with corticosteroid injections, result in successful symptom control in most cases. According to literature, surgical decompression in refractory cases appears generally safe and effective. 10 patients who underwent neurolysis at our center were retrospectively analyzed; complete pain relief was achieved in 50% of patients, and partial relief in 40%. No complications were seen. Conclusion: MP is a compressive neuropathy of the thigh. Primary treatment consists of conservative measures, supplemented with corticosteroid infiltrations. Surgical decompression in refractory cases is safe and effective. Future randomized studies are needed to establish optimal treatment guidelines.