Complications following sural and peroneal nerve biopsies

Hilton, David A.; Jacob, John Roshan; Househam, Liz; Tengah, Connie

doi:10.1136/jnnp.2007.116368

Cited by 48 publications

(36 citation statements)

References 16 publications

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“…One study of NSVN patients did compare the sensitivity of SPN/PBM versus sural nerve biopsy in the diagnosis of definite vasculitis and found increased sensitivity of 58% versus 47%, respectively, but this was not statistically significant 6. A recent study comparing complications following SPN/PBM versus sural nerve biopsy has shown that although SPN biopsy can lead to a greater area of sensory loss compared with sural nerve biopsy, there is very little difference in other complications 24. Differences in the published diagnostic yield of combined nerve and muscle biopsy may also relate to the case mix (eg, the proportion of SVN versus NSVN cases) and the stringency of the criteria used to define vasculitis in peripheral nerve and muscle.…”

Section: Discussionmentioning

confidence: 99%

The use of nerve and muscle biopsy in the diagnosis of vasculitis: a 5 year retrospective study

Bennett

Groves

Blake

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

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Introduction:Peripheral nerve vasculitis is an important condition which can be diagnostically challenging and is one of the principal current indications for nerve and muscle biopsy. Previous studies have suggested that combined nerve and muscle biopsy (usually of the superficial peroneal nerve and peroneus brevis muscle) produces a higher diagnostic yield than nerve biopsy alone in the investigation of vasculitis.Objective:To determine whether in our two centres combined nerve (usually the sural) and muscle (usually the vastus lateralis) biopsy improved diagnostic yield compared with nerve biopsy alone.Methods:We interrogated our database of all nerve biopsies (usually of the sural nerve) performed at our institutions over 5 years and identified 53 cases of biopsy proven peripheral nerve vasculitis. Clinicopathological and neurophysiological data in these patients were reviewed.Results:The most common clinical presentation was with a painful asymmetric axonal polyneuropathy or mononeuritis multiplex (66% of cases). Nerve biopsy demonstrated definite vasculitis in 36%, probable vasculitis in 62% and no vasculitis in 2% of cases. In 24 patients a muscle biopsy (usually the vastus lateralis) was also performed and vasculitis was demonstrated in 46% of these (in 13% showing definite and 33% probable vasculitis). There was only one patient in whom vasculitis was demonstrated in muscle but not in peripheral nerve.Conclusion:Combined nerve (usually sural) and vastus lateralis muscle biopsy did not significantly increase the diagnostic yield compared with nerve biopsy alone. A sensible approach to the diagnosis of peripheral nerve vasculitis is to choose a nerve to biopsy which is clinically affected and amenable to biopsy. If the sural nerve is chosen, the data suggest that it is not routinely worth doing a vastus lateralis biopsy at the same time, whereas if the superficial peroneal nerve is chosen, it seems appropriate to do a combined superficial peroneal nerve and peroneus brevis biopsy. It is still not known if both the sural and superficial peroneal nerves are involved clinically which one gives the higher yield if biopsied.

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Section: Discussionmentioning

confidence: 99%

The use of nerve and muscle biopsy in the diagnosis of vasculitis: a 5 year retrospective study

Bennett

Groves

Blake

et al. 2008

Journal of Neurology, Neurosurgery & Psychiatry

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“…Peripheral nerve biopsy is a safe investigation, which, if performed and analyzed in an appropriate setting, can enhance the diagnostic yield of complex patients [86]. However, most guidelines, are adult based and few exist with pediatric emphasis [17,21].…”

Section: Peripheral Nerve Biopsymentioning

confidence: 99%

Diagnosis and Management of Pediatric Peripheral Neuropathies In Resource-Poor Settings

Wilmshurst

2013

Future Neurol.

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The diagnosis of a peripheral neuropathy in a child who resides in the majority of resource-poor settings is based on the history taken and the clinical examination. The majority of children, unless they demonstrate additional clinical markers, will lack a more definitive diagnosis beyond the label ‘peripheral neuropathy’. The treatable, typically acquired conditions, which are prevalent in these settings, are the priority to identify. This would include neuroinfections, neuroinflammation, toxins and vitamin deficiencies. The management of children with peripheral neuropathies in resource-poor settings must be approached in a different manner to that of more ‘resource-equipped’ settings. Secondary or tertiary centers are scarce, often significant distances away from the patient, and this leads to long delays before access is possible. Most children present to primary healthcare settings and are seen by practitioners with little training in the features suggestive of a peripheral neuropathy. As such, basic aids to assist the healthcare worker in the early recognition and interventions of a child with a peripheral neuropathy are important. In addition, there must be recognition of the child with a rapidly progressive neuropathy where a life-threatening condition is present, and urgent referral to a tertiary setting made wherever possible.

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“…Peripheral neuropathy can occur either as a part of systemic vasculitis, such as polyarteritis nodosa, connective tissue diseases and antineutrophil cytoplasmic antibody‐associated vasculitides, or as non‐systemic vasculitic neuropathy (NSVN), which is a disorder restricted to peripheral nerves . Characteristic pathological features of vasculitic nerve fragments are essential for diagnosis, but the diagnostic yield of nerve biopsy is modest despite its invasiveness and sequelae, such as sensory loss or pain …”

Section: Introductionmentioning

confidence: 99%

Combined nerve/muscle/skin biopsy could increase diagnostic sensitivity for vasculitic neuropathy

Masuda

Misawa

Arai

et al. 2015

Clinical & Exp Neuroim

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Objective Combined nerve/muscle biopsy is widely carried out to improve the diagnostic sensitivity for vasculitic neuropathy. However, an additional yield of muscle biopsy is modest. Therefore, we investigated whether skin biopsy in combination with nerve/muscle biopsy increases the detection rate of vasculitis. Methods A total of 25 combined nerve/muscle/skin biopsy samples from patients with biopsy-proven necrotizing vasculitis (n = 16) or clinically probable vasculitic neuropathy (n = 9) were reviewed. Specimens from the sural nerve, peroneus brevis muscle and skin were obtained simultaneously by a single incision. Results Skin biopsy substantially contributed to diagnosis of vasculitic neuropathy. Additional skin biopsy enhanced diagnostic sensitivity from 88% to 100% in patients with pathologically confirmed vasculitis (n = 16). Vasculitis was detected only in skin specimens from two of the entire cohort (n = 25). There were no complications related to skin collection, such as anastomotic leakage or wound infection. Conclusion Combined nerve/muscle/skin biopsy could be a less invasive option to improve the diagnostic sensitivity for vasculitis.

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Complications following sural and peroneal nerve biopsies

Cited by 48 publications

References 16 publications

The use of nerve and muscle biopsy in the diagnosis of vasculitis: a 5 year retrospective study

The use of nerve and muscle biopsy in the diagnosis of vasculitis: a 5 year retrospective study

Diagnosis and Management of Pediatric Peripheral Neuropathies In Resource-Poor Settings

Combined nerve/muscle/skin biopsy could increase diagnostic sensitivity for vasculitic neuropathy

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