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Diagnostic Approach in Nerve Biopsy
Published in Maher Kurdi, Neuromuscular Pathology Made Easy, 2021
Microscopic inspection of nerve biopsy tissue requires clinical and pathological correlation. Electrodiagnostic tests usually direct pathologists to the correct track to follow. Because histological changes are sometimes subtle, pathologists should follow a systematic approach to evaluate abnormal findings seen in biopsy (Figure 25.1). Indeed, relating the pathology to the clinical picture is paramount to diagnosis.
Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Nerve biopsy: An axonopathy sparing unmyelinated fibers.Marked loss of myelinated fibers.Demyelination is neither prominent nor it is in the usual central predominant pattern seen in vasculitic neuropathies.Epineural and perineural granuloma with or without periangiitis and panangiitis.
Diagnostic algorithms for painful peripheral neuropathy
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
As a general principle, nerve biopsy should be reserved for situations where it may be helpful in the diagnosis of a potentially treatable cause of neuropathy. Examples of such indications when investigating painful neuropathy would include vasculitis,17,18 sarcoidosis,19 and amyloid neuropathy20 (see Figure 7.1). As well as revealing the underlying cause of the neuropathy, it is also helpful in classification into axonal versus demyelinating forms. In the context of small-fiber neuropathies, the number of unmyelinated fibers within the nerve can be quantified;21 however, this requires electron microscopy, is time consuming, and may not fully reflect the degree of unmyelinated fiber degeneration.22,23[II] The reason for a conservative approach in the use of nerve biopsy is that it is associated with a significant morbidity. Following nerve biopsy, up to 20 percent of patients report pain at the biopsy site six months following the procedure.24 Other side effects include sensory loss and infection. The decision as to which nerve to biopsy is usually made on the basis of finding a sensory nerve which is both clinically affected and in which neurophysiology confirms a reduced or absent sensory action potential. In practice, this usually means taking the sural or superficial peroneal nerve. It is important to understand that only certain nerves are suitable for biopsy, and pathology may be proximal to the biopsy site. In certain situations, such as vasculitic neuropathy, diagnostic yield is increased by taking combined nerve and muscle biopsies.17,25 In selected patients, this procedure remains very helpful. One study has looked prospectively at the usefulness of nerve biopsy and found that in 60 percent of patients this investigation changed or was helpful in guiding the management of patients.24
Contemporary challenges in the diagnosis and management of chronic inflammatory demyelinating polyneuropathy
Published in Expert Review of Neurotherapeutics, 2022
Although considered mandatory for a definitive diagnosis of CIDP by older criteria [53], nerve pathology has since been convincingly shown to be of little value in most patients with suspected CIDP [54]. This is because pathological findings are diverse, poorly sensitive, and mostly nonspecific. Furthermore, results are highly dependent on the availability of adequate neuropathological laboratory facilities and the expertise of neuropathologists with experience in peripheral nerve disease [55]. For those reasons, nerve biopsy is only justified in cases of suspected CIDP with no response to treatment and when alternative, especially treatable disorders are possible. However, even in these cases, specified within the updated guidelines, it is highly debatable as to whether neuropathology adds real benefit, particularly as other noninvasive and reliable diagnostic methods are available when alternative diagnoses are under consideration. Furthermore, the potential complications of nerve biopsy, although rare, should be taken into account. As such, for diagnosis of CIDP itself, it appears only exceptionally justified to perform a nerve biopsy, with few studies suggesting it may be more frequently useful, importantly coming from highly specialized units [56].
Isolating the Superficial Peroneal Nerve Motor Branch to the Peroneus Longus Muscle with Concentric Stimulation during Diagnostic Motor Nerve Biopsy
Published in The Neurodiagnostic Journal, 2022
Ashley Rosenberg, Rachel Pruitt, Sami Saba, Justin W. Silverstein, Randy S. D’Amico
Motor nerve biopsy is a frequent final diagnostic tool to distinguish motor neuropathy from motor neuron disease and may be performed with associated muscle biopsy to diagnose myopathy in patients with focal or diffuse motor weakness. Accurate diagnosis is critical as treatment with immunoglobulin can be effective in select motor neuropathies (Latov et al. 1988; Pestronk et al. 1988). Biopsy of the gracilis muscle and obturator nerve, and the pronator teres muscle and the motor branch of the median nerve supplying it, have been described for diagnosis in suspected lower or upper extremity disease processes, respectively (Berman et al. 1985; Corbo et al. 1997; Dy et al. 2012; Kinoshita et al. 2014). Recently, a technique to biopsy the motor branch to the peroneus longus muscle was described as adequate and sufficient to enable diagnosis in patients with suspected motor neuropathy (D’Amico and Winfree 2017). We describe our techniques for intraoperative neuromonitoring for preservation of motor function during this approach which, to-date have not been described.
Fascicular turnover flap in the reconstruction of facial nerve defects: an experimental study in rats
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Miyuki Uehara, Wu Wei Min, Moriaki Satoh, Fumiaki Shimizu
The clinical utility of fascicular components as the source of axonal regeneration is well recognized [21,22]. In 1994, Oberlin et al. reported the successful reconstruction of elbow flexion using a separated fascicular flap from an ulnar nerve wherein the distal end was sutured to the musculocutaneous nerve in brachial plexus injury patients [21]. Terzis et al. reported the utility of a separated nerve fascicle of the hypoglossal nerve as the motor source for facial nerve reconstruction [21]. However, the clinical utility of the retrograde fascicular component in reconstructing the nerve gap had not been reported. Koshima et al. [19,20] reported the clinical utility of a fascicular turnover flap. In this report, a digital nerve defect, as well as a the facial nerve gap, was reconstructed with a fascicular turnover flap. Ito et al. [23] successfully applied this procedure to reconstruct a nerve gap after a nerve biopsy. However, the clinical indications and mechanism underlying this procedure remain unclear, and to our knowledge, no comparative study has yet been performed between a traditional autologous nerve graft and a fascicular turnover flap.