Tips, quips, and pearlsTechnique of the Sural Nerve Biopsy
Section snippets
Technique
The surgical technique for attaining an adequate specimen has been described in detail by Dyck et al (7). The procedure is performed as an outpatient while the patient is under local anesthetic with or without conscious sedation. The patient is positioned supine on the operating room table, with a bolster under the ipsilateral hip and the foot slightly everted to relax the sural nerve (7). No tourniquet is used, and bipolar cautery is used for hemostasis to avoid damaging the specimen or
Potential Complications
Theriault et al (11) carried out a detailed review of the neurological deficits and complications after whole sural nerve biopsy. Postoperative symptoms were described as irritating (78%) but not painful; allodynia was present in 19% at 12 months; and on a scale of discomfort 0 to 10, the rating at 12 months was 3.0. After fascicular biopsy, Solders (12) reported that after 6 months, 11% of patients had significant discomfort, which was described as pinprick or a “tight” sensation during
Conclusion
Although a sural nerve biopsy can be a valuable tool and greatly contribute to establishing a diagnosis for peripheral neuropathy, it should be reserved for cases that cannot be diagnosed by other means. Performing the biopsy is not a technically difficult procedure given the relatively superficial anatomic location of the sural nerve. However, patients should be carefully informed of the risks of long-lasting discomfort, sensory deficit, infection, and wound dehiscence. It is the
Acknowledgment
We thank Dr. David Z. Shechter for his help with this manuscript.
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Cited by (24)
Pathology of human diabetic neuropathy
2014, Handbook of Clinical NeurologyCitation Excerpt :This chapter will consider the significant contribution that sural nerve biopsy studies have made to our understanding of the pathology and pathogenesis of human diabetic neuropathy and will then also evaluate the increasing contribution of recent studies utilizing skin biopsies (Lauria and Lombardi, 2012) and the novel technique of corneal confocal microscopy in evaluating human diabetic neuropathy (Quattrini et al., 2007; Umapathi et al., 2007; Loseth et al., 2008). The majority of nerve biopsy studies have been undertaken in the sural nerve due to the fact that it is distal, sensory, and relatively easy to biopsy (Bevilacqua et al., 2007). In the upper limb the posterior interosseous nerve, a sensory branch of the radial nerve, has also been biopsied and studied (Thomsen et al., 2009a).
Clinical and diagnostic features of small fiber damage in diabetic polyneuropathy
2014, Handbook of Clinical NeurologyMuscle and nerve biopsies: Techniques for the neurologist and neurosurgeon
2013, Clinical Neurology and NeurosurgeryCitation Excerpt :The sural nerve or superficial peroneal nerves are often chosen for conditions affecting the lower extremities, while the superficial radial sensory nerve is often chosen for conditions of the upper extremities. Importantly, the sural nerve and the superficial radial nerve are purely sensory and autonomic [36–38]. Generally, sensory nerves are sampled to avoid the creation of a motor deficit.
When and how to perform biopsies in a patient with a (suspected) connective tissue disease
2013, Best Practice and Research: Clinical RheumatologyUltrasound-Assisted Sural Nerve Biopsy: Technical Note and Correlation of Ultrasound Imaging with Operative Findings
2013, Journal of Medical UltrasoundCitation Excerpt :These characteristics make the sural nerve the most commonly biopsied peripheral nerve. In conventional sural nerve biopsies, the lesser saphenous vein is used as the most reliable landmark [2]. However, in cases where there is variation of sural nerve location, it is possible that a surgeon can become disoriented during surgical exploration without seeing the sural nerve beforehand.
- 1
Fellow, Center for Lower Extremity Ambulatory Research (CLEAR), Clinical Instructor; Department of Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.
- 2
Fellow, Center for Lower Extremity Ambulatory Research (CLEAR), Clinical Instructor; Department of Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.
- 3
Senior Lecturer and Consultant Physician, Cardiovascular Research Group, Division of Cardiovascular and Endocrine Sciences, Manchester Royal Infirmary and University of Manchester, Manchester, United Kingdom.
- 4
Director, Center for Lower Extremity Ambulatory Research (CLEAR), Professor of Surgery and Associate Dean, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL.