Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Oct;69(4):442–446. doi: 10.1136/jnnp.69.4.442

Prospective study of the usefulness of sural nerve biopsy

C Gabriel 1, R Howard 1, N Kinsella 1, S Lucas 1, I McColl 1, G Saldanha 1, S Hall 1, R Hughes 1
PMCID: PMC1737127  PMID: 10990501

Abstract

OBJECTIVE—This study aimed to determine the usefulness of sural nerve biopsy in neurological practice.
METHODS—The first prospective study of sural nerve biopsy in 50 consecutive patients was undertaken. The investigating neurologist declared the prebiopsy diagnosis and management plan and after 3 months an independent neurologist evaluated the contribution of the biopsy to diagnosis and management. An independent audit officer sought information from the patient about the adverse effects and value of the biopsy after 6 weeks and 6months.
RESULTS—In seven cases the nerve biopsy changed the diagnosis, in 35 cases the biopsy confirmed the suspected diagnosis, and in eight cases the biopsy was non-contributory. The biopsy either changed or was helpful in guiding patient management in 60%, especially those with demyelinating neuropathy and multiple mononeuropathy. Seven patients reported having had infection and 10 reported increased pain at the biopsy site 6 months later.
CONCLUSION—In a consecutive series of 50 cases, sural nerve biopsy altered the diagnosis in 14%, affected management in 60%, and caused persistent increased pain at the biopsy site in 33%.



Full Text

The Full Text of this article is available as a PDF (185.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Argov Z., Steiner I., Soffer D. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989 Mar;79(3):243–245. doi: 10.1111/j.1600-0404.1989.tb03745.x. [DOI] [PubMed] [Google Scholar]
  2. Argov Z., Steiner I., Soffer D. The yield of sural nerve biopsy in the evaluation of peripheral neuropathies. Acta Neurol Scand. 1989 Mar;79(3):243–245. doi: 10.1111/j.1600-0404.1989.tb03745.x. [DOI] [PubMed] [Google Scholar]
  3. Chia L., Fernandez A., Lacroix C., Adams D., Planté V., Said G. Contribution of nerve biopsy findings to the diagnosis of disabling neuropathy in the elderly. A retrospective review of 100 consecutive patients. Brain. 1996 Aug;119(Pt 4):1091–1098. doi: 10.1093/brain/119.4.1091. [DOI] [PubMed] [Google Scholar]
  4. Diss T. C., Peng H., Wotherspoon A. C., Isaacson P. G., Pan L. Detection of monoclonality in low-grade B-cell lymphomas using the polymerase chain reaction is dependent on primer selection and lymphoma type. J Pathol. 1993 Mar;169(3):291–295. doi: 10.1002/path.1711690303. [DOI] [PubMed] [Google Scholar]
  5. Dyck P. J., Lofgren E. P. Nerve biopsy. Choice of nerve, method, symptoms, and usefulness. Med Clin North Am. 1968 Jul;52(4):885–893. [PubMed] [Google Scholar]
  6. Hughes R., Atkinson P., Coates P., Hall S., Leibowitz S. Sural nerve biopsies in Guillain-Barre syndrome: axonal degeneration and macrophage-associated demyelination and absence of cytomegalovirus genome. Muscle Nerve. 1992 May;15(5):568–575. doi: 10.1002/mus.880150506. [DOI] [PubMed] [Google Scholar]
  7. Neundörfer B., Grahmann F., Engelhardt A., Harte U. Postoperative effects and value of sural nerve biopsies: a retrospective study. Eur Neurol. 1990;30(6):350–352. doi: 10.1159/000117372. [DOI] [PubMed] [Google Scholar]
  8. Oh S. J. Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J. 1990 Mar;31(1):1–26. doi: 10.3349/ymj.1990.31.1.1. [DOI] [PubMed] [Google Scholar]
  9. Poburski R., Malin J. P., Stark E. Sequelae of sural nerve biopsies. Clin Neurol Neurosurg. 1985;87(3):193–198. doi: 10.1016/0303-8467(85)90006-x. [DOI] [PubMed] [Google Scholar]
  10. Pollock M., Nukada H., Taylor P., Donaldson I., Carroll G. Comparison between fascicular and whole sural nerve biopsy. Ann Neurol. 1983 Jan;13(1):65–68. doi: 10.1002/ana.410130114. [DOI] [PubMed] [Google Scholar]
  11. Pollock M., Nukada H., Taylor P., Donaldson I., Carroll G. Comparison between fascicular and whole sural nerve biopsy. Ann Neurol. 1983 Jan;13(1):65–68. doi: 10.1002/ana.410130114. [DOI] [PubMed] [Google Scholar]
  12. Solders G. Discomfort after fascicular sural nerve biopsy. Acta Neurol Scand. 1988 Jun;77(6):503–504. doi: 10.1111/j.1600-0404.1988.tb05948.x. [DOI] [PubMed] [Google Scholar]
  13. Theriault M., Dort J., Sutherland G., Zochodne D. W. A prospective quantitative study of sensory deficits after whole sural nerve biopsies in diabetic and nondiabetic patients. Surgical approach and the role of collateral sprouting. Neurology. 1998 Feb;50(2):480–484. doi: 10.1212/wnl.50.2.480. [DOI] [PubMed] [Google Scholar]
  14. Vital A., Latinville D., Aupy M., Dumas P., Vital C. Inflammatory demyelinating lesions in two patients with IgM monoclonal gammopathy and polyneuropathy. Neuropathol Appl Neurobiol. 1991 Oct;17(5):415–420. doi: 10.1111/j.1365-2990.1991.tb00741.x. [DOI] [PubMed] [Google Scholar]
  15. Wan J. H., Trainor K. J., Brisco M. J., Morley A. A. Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction. J Clin Pathol. 1990 Nov;43(11):888–890. doi: 10.1136/jcp.43.11.888. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES