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

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OBJECTIVE

Meralgia 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.

METHODS

Thirty-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.

RESULTS

The 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.

CONCLUSIONS

This 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.

ABBREVIATIONS ASIS = anterior superior iliac spine; LFCN = lateral femoral cutaneous nerve; MP = meralgia paresthetica.
Article Information

Contributor Notes

Correspondence Ming Zhang: University of Otago, Dunedin, New Zealand. ming.zhang@anatomy.otago.ac.nz.INCLUDE WHEN CITING Published online December 7, 2018; DOI: 10.3171/2018.7.JNS181596.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Aldrich EFvan den Heever CM: Suprainguinal ligament approach for surgical treatment of meralgia paresthetica. Technical note. J Neurosurg 70:4924941989

    • Search Google Scholar
    • Export Citation
  • 2

    Aszmann OCDellon ESDellon AL: Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 100:6006041997

    • Search Google Scholar
    • Export Citation
  • 3

    Carai AFenu GSechi ECrotti FMMontella A: Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat 22:3653702009

    • Search Google Scholar
    • Export Citation
  • 4

    Cheatham SWKolber MJSalamh PA: Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 8:8838932013

  • 5

    de Ruiter GCWKloet F: Anatomical considerations on transposition of the lateral femoral cutaneous nerve. Clin Anat [epub ahead of print]2018

    • Search Google Scholar
    • Export Citation
  • 6

    de Ruiter GCWWurzer JALKloet A: Decision making in the surgical treatment of meralgia paresthetica: neurolysis versus neurectomy. Acta Neurochir (Wien) 154:176517722012

    • Search Google Scholar
    • Export Citation
  • 7

    Dias Filho LCValença MMGuimarães Filho FAMedeiros RCSilva RAMorais MG: Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat 16:3093162003

    • Search Google Scholar
    • Export Citation
  • 8

    Hanna A: The lateral femoral cutaneous nerve canal. J Neurosurg 126:9729782017

  • 9

    Hanna A: Transposition of the lateral femoral cutaneous nerve. J Neurosurg [epub ahead of print April 13 2018; DOI: 10.3171/2017.8.JNS171120]

    • Search Google Scholar
    • Export Citation
  • 10

    Hanna AHanna B: Response to: Anatomical considerations on transposition of the lateral femoral cutaneous nerve. Clin Anat [epub ahead of print] 2018

    • Search Google Scholar
    • Export Citation
  • 11

    Hanna AS: Lateral femoral cutaneous nerve transposition: renaissance of an old concept in the light of new anatomy. Clin Anat 30:4094122017

    • Search Google Scholar
    • Export Citation
  • 12

    Hanna ASEhlers MELee KS: Preoperative ultrasound-guided wire localization of the lateral femoral cutaneous nerve. Oper Neurosurg (Hagerstown) 13:4024082017

    • Search Google Scholar
    • Export Citation
  • 13

    Ivins GK: Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg 232:2812862000

  • 14

    Jefferson DEames RA: Subclinical entrapment of the lateral femoral cutaneous nerve: an autopsy study. Muscle Nerve 2:1451541979

  • 15

    Keegan JJHolyoke EA: Meralgia paresthetica. An anatomical and surgical study. J Neurosurg 19:3413451962

  • 16

    Liugan MXu ZZhang M: Reduced free communication of the subarachnoid space within the optic canal in the human. Am J Ophthalmol 179:25312017

    • Search Google Scholar
    • Export Citation
  • 17

    Majkrzak AJohnston JKacey DZeller J: Variability of the lateral femoral cutaneous nerve: An anatomic basis for planning safe surgical approaches. Clin Anat 23:3043112010

    • Search Google Scholar
    • Export Citation
  • 18

    Nahabedian MYDellon AL: Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg 35:5905941995

    • Search Google Scholar
    • Export Citation
  • 19

    Nielsen TDMoriggl BBarckman JKølsen-Petersen JASøballe KBørglum J: The lateral femoral cutaneous nerve: description of the sensory territory and a novel ultrasound-guided nerve block technique. Reg Anesth Pain Med 43:3573662018

    • Search Google Scholar
    • Export Citation
  • 20

    Patijn JMekhail NHayek SLataster Avan Kleef MVan Zundert J: Meralgia paresthetica. Pain Pract 11:3023082011

  • 21

    Pearce JM: Meralgia paraesthetica (Bernhardt-Roth syndrome). J Neurol Neurosurg Psychiatry 77:842006

  • 22

    Ropars MMorandi XHuten DThomazeau HBerton EDarnault P: Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat 31:1992042009

    • Search Google Scholar
    • Export Citation
  • 23

    Siu TLChandran KN: Neurolysis for meralgia paresthetica: an operative series of 45 cases. Surg Neurol 63:19232005

  • 24

    Son BCKim DRKim ISHong JTSung JHLee SW: Neurolysis for meralgia paresthetica. J Korean Neurosurg Soc 51:3633662012

  • 25

    Standring S: Gray’s Anatomy: The Anatomical Basis of Clinic Practiceed 40. London: Churchill Livingstone Elsevier, 2008 pp 1064135113521382

    • Search Google Scholar
    • Export Citation
  • 26

    Tomaszewski KAPopieluszko PHenry BMRoy JSanna BKijek MR: The surgical anatomy of the lateral femoral cutaneous nerve in the inguinal region: a meta-analysis. Hernia 20:6496572016

    • Search Google Scholar
    • Export Citation
  • 27

    Üzel MAkkin SMTanyeli EKoebke J: Relationships of the lateral femoral cutaneous nerve to bony landmarks. Clin Orthop Relat Res 469:260526112011

    • Search Google Scholar
    • Export Citation
  • 28

    Xu ZChapuis PHBokey LZhang M: Denonvilliers’ fascia in men: a sheet plastination and confocal microscopy study of the prerectal space and the presence of an optimal anterior plane when mobilizing the rectum for cancer. Colorectal Dis 20:2362422017

    • Search Google Scholar
    • Export Citation
  • 29

    Xu ZChapuis PHBokey LZhang M: Nature and architecture of the puboprostatic ligament: a macro- and microscopic cadaveric study using epoxy sheet plastination. Urology 110:263.e1263.e82017

    • Search Google Scholar
    • Export Citation
  • 30

    Zhang MAn PC: Liliequist’s membrane is a fold of the arachnoid mater: study using sheet plastination and scanning electron microscopy. Neurosurgery 47:9029092000

    • Search Google Scholar
    • Export Citation
  • 31

    Zhu JZhao YLiu FHuang YShao JHu B: Ultrasound of the lateral femoral cutaneous nerve in asymptomatic adults. BMC Musculoskelet Disord 13:2272012

    • Search Google Scholar
    • Export Citation
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