The nerve biopsy: indications, technical aspects, and contribution

This chapter discusses the indications for biopsying a peripheral nerve and the factors involved in justifying this decision and then deciding which nerve to take. There is a table summarizing some of the causes of neuropathy and attempting to relate these to the probability that nerve biopsy would be helpful in diagnosis. The surgical procedure for the nerve biopsy is described including aftercare and possible complications. The techniques involved in processing and staining the nerve are discussed. This section includes the possibilities of creating artefactual damage by mishandling or poor technique, and how to avoid these. Modification to the standard resin processing schedule to allow the teasing out of individual nerve fibers is briefly described, as are methods for measuring fiber density, fiber size and myelin thickness. There is also a brief discussion of the applications of immunohistochemistry. This is followed by a section on interpretation by light and electron microscopy in which some of the more important diagnostic features are described and illustrated, as are nonspecific morphological findings. Interpretation of teased fiber preparations is discussed. Finally, some common causes of incorrect interpretation are mentioned.