The intercostal nerve as a target for diagnostic biopsy

Area of Science:

• Neurology
• Surgical Pathology
• Peripheral Nervous System Disorders

Background:

• Peripheral nerve biopsy is crucial for diagnosing neuropathies.
• Sural and gracilis nerve biopsies have limitations, especially for motor neuropathies.
• Alternative biopsy targets are needed to improve diagnostic yield and safety.

Purpose of the Study:

• To evaluate the intercostal nerve as an alternative biopsy target for peripheral neuropathies.
• To assess the feasibility, safety, and diagnostic utility of intercostal nerve biopsy.

Main Methods:

• Intercostal nerve biopsy (targeting T7-T11) was performed on 4 patients with suspected peripheral neuropathies.
• Procedure involved selecting a rib interspace, isolating the nerve via blunt dissection, and excising a segment for pathological examination.
• Operative time and blood loss were recorded; patients were monitored for complications and functional deficits.

Main Results:

• Average operative time was 73 minutes with an average blood loss of 8 ml.
• Biopsy results revealed axonopathy in one patient and axonopathy with demyelination in three patients.
• No short- or long-term postoperative complications were observed; no sensory or motor deficits were reported at 6 weeks.

Conclusions:

• Intercostal nerve biopsy is a safe and effective alternative for diagnosing peripheral neuropathies.
• It is particularly suitable for patients with predominantly motor neuropathies due to its mixed nerve fibers and minimal risk of motor impairment.
• The straightforward anatomy and minimal risk of deficits make it a valuable option.