Abstract
Background
Brachial and lumbosacral plexopathies can result from numerous non-traumatic etiologies, including those of inflammatory, autoimmune, or neoplastic origin, that often require nerve biopsy for diagnosis. The purpose of this study was to evaluate the diagnostic efficacy of medial antebrachial cutaneous nerve (MABC) and posterior femoral cutaneous nerve (PFCN) nerve biopsies in proximal brachial and lumbosacral plexus pathology.
Method
Patients undergoing MABC or PFCN nerve biopsies at a single institution were reviewed. Patient demographics, clinical diagnosis, symptom duration, intraoperative findings, post-operative complications, and pathology results were recorded. Biopsy results were classified as diagnostic, inconclusive, or negative based on the final pathology.
Results
Thirty patients undergoing MABC biopsies in the proximal arm or axilla and five patients with PFCN biopsies in the thigh or buttock were included. MABC biopsies were diagnostic in 70% of cases overall and 85% diagnostic in cases where pre-operative MRI also demonstrated abnormalities in the MABC. PFCN biopsies were diagnostic in 60% of cases overall and in 100% of patients with abnormal pre-operative MRIs. There were no biopsy-related post-operative complications in either group.
Conclusions
In diagnosing non-traumatic etiologies of brachial and lumbosacral plexopathies, proximal biopsies of the MABC and PFCN provide high diagnostic value with low donor morbidity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Amrami KK, Felmlee JP, Spinner RJ (2008) MRI of peripheral nerves. Neurosurg Clin N Am 19(4):559–572
Berini SE, Dyck PJB (2019) The utility of nerve biopsy in carefully selected patients in modern neuromuscular practice. Muscle Nerve 59(6):635–637
Bourque PR, Warman Chardon J, Bryanton M, Toupin M, Burns BF, Torres C (2018) Neurolymphomatosis of the brachial plexus and its branches: case series and literature review. Can J Neurol Sci 45(2):137–143
Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C (2019) Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 19(1):1149
Capek S, Howe BM, Amrami KK, Spinner RJ (2015) Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns. Neurosurg Focus 39(3):E14
Capek S, Amrami KK, Howe BM, Salomao DR, Dyck PJ, Spinner RJ (2015) Perineural spread of squamous cell carcinoma: from skin to skin through the brachial plexus. Clin Neurol Neurosurg 128:90–93
Capek S, Sullivan PS, Howe BM et al (2015) Recurrent rectal cancer causing lumbosacral plexopathy with perineural spread to the spinal nerves and the sciatic nerve: an anatomic explanation. Clin Anat 28(1):136–143
Capek S, Krauss WE, Amrami KK, Parisi JE, Spinner RJ (2016) Perineural spread of renal cell carcinoma: a case illustration with a proposed anatomic mechanism and a review of the literature. World Neurosurg 89(728):e711–e727
Chang KV, Mezian K, Nanka O, Wu WT, Lou YM, Wang JC et al (2018) Ultrasound imaging for the cutaneous nerves of the extremities and relevant entrapment syndormes: from anatomy to clinical implications. J Clin Med 7(11):457
Collins MP, Dyck PJ, Gronseth GS et al (2010) Peripheral Nerve Society Guideline on the classification, diagnosis, investigation, and immunosuppressive therapy of non-systemic vasculitic neuropathy: executive summary. J Peripher Nerv Syst 15(3):176–184
Deprez M, de Groote CC, Gollogly L, Reznik M, Martin JJ (2000) Clinical and neuropathological parameters affecting the diagnostic yield of nerve biopsy. Neuromuscul Disord 10(2):92–98
Dyck PJ, Lofgren EP (1968) Nerve biopsy. Choice of nerve, method, symptoms, and usefulness. Med Clin North Am 52(4):885–893
Hebert-Blouin MN, Amrami KK, Myers RP, Hanna AS, Spinner RJ (2010) Adenocarcinoma of the prostate involving the lumbosacral plexus: MRI evidence to support direct perineural spread. Acta Neurochir (Wien) 152(9):1567–1576
Koike H, Tanaka F, Sobue G (2011) Paraneoplastic neuropathy: wide-ranging clinicopathological manifestations. Curr Opin Neurol 24(5):504–510
Ladha SS, Spinner RJ, Suarez GA, Amrami KK, Dyck PJ (2006) Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: an unusual entity. Muscle Nerve 34(5):659–665
Marek T, Howe BM, Amrami KK, Spinner RJ (2018) Perineural spread of nonmelanoma skin cancer to the brachial plexus: identifying anatomic pathway(s). World Neurosurg 114:e818–e823
Marek T, Laughlin RS, Howe BM, Spinner RJ (2018) Perineural spread of melanoma to the brachial plexus: identifying the anatomic pathway(s). World Neurosurg 111:e921–e926
Marek T, Stone JJ, Amrami KK, Spinner RJ (2018) Targeted nerve biopsy: a technique in evolution. Clin Anat 31(8):1200–1204
Marek T, Howe BM, Amrami KK, Spinner RJ (2018) From targeted fascicular biopsy of major nerve to targeted cutaneous nerve biopsy: implementing clinical anatomy can catalyze a paradigm shift. Clin Anat 31(5):616–621
Mathey EK, Park SB, Hughes RA et al (2015) Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry 86(9):973–985
Molenaar DS, Vermeulen M, de Haan R (1998) Diagnostic value of sural nerve biopsy in chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry. 64(1):84–89
Tharin BD, Kini JA, York GE, Ritter JL (2014) Brachial plexopathy: a review of traumatic and nontraumatic causes. AJR Am J Roentgenol 202(1):W67–W75
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nikhil K. Murthy, Kitty Y. Wu, Benjamin M. Howe, and P. James B. Dyck. The first draft of the manuscript was written by Nikhil K. Murthy, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Mayo Clinic) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Consent to participate
The patients gave consent to the use of their information for research purposes and publication.
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wu, K.Y., Murthy, N.K., Howe, B.M. et al. Diagnostic value of proximal cutaneous nerve biopsy in brachial and lumbosacral plexus pathologies. Acta Neurochir 165, 1189–1194 (2023). https://doi.org/10.1007/s00701-023-05565-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-023-05565-y