Abstract
Objectif Nerve biopsy is useful in the diagnosis and the management of neuromuscular disorders and is commonly performed in distal, noncritical sensory nerves without using imaging to target the most involved regions. In general, these procedures are diagnozed in 20–50%. In selected cases where preoperative evaluation points towards a more localized (usually a more proximal) process, targeted biopsy would likely capture the disease. Synthesis of data obtained from clinical examination, electrophysiological testing and MRI allows a targeted fascicular biopsy of a major nerves to be performed safely and efficiently. Herein, our experiences with the brachial plexus are reported and a description of the operative technique is provided. Methods All cases of brachial plexus biopsy performed between 2003 and 2015 were reviewed. Only cases of targeted nerve biopsy approached from supraclavicular, deltopectoral and proximal medial arm were included. Demographic data, clinical presentation and the presence of percussion tenderness for each patient were recorded. Reviewed studies included electrodiagnostic tests and high resolution MR imaging. Previous nerve and muscle biopsies were noted. All details of the procedure, final pathology and its treatment implications were recorded. The complication rate was carefully assessed for temporary as well as permanent complications. Results Seventy-seven cases (29 men and 48 women) of brachial plexus biopsy were performed. Mean patient age was 57.25 years. Sixty-eight (87.1%) patients presented with symptoms in one upper extremity, 8 (10.4%), in both upper limbs, and 1 (17%), with all limb. All 74 patients (100%) patients had abnormal physical examinations, electrodiagnostic studies and MRIs. The overall diagnostic yield of biopsy was 74.4% ( n = 55). The most common diagnoses included breast carcinoma (17), neurolymphomatosis (9), inflammatory demyelination (13), perineurinoma (7) and nonspecific inflammatory changes (4). The series included 4 cases of (5.4%) increased numbness and 3 (4.0%) with additional weakness. Conclusion Targeted fascicular biopsy of the brachial plexus is an efficient diagnostic procedure and in highly selected cases can be offered as the initial procedure over distal cutaneous nerve biopsy. Diagnoses were very diverse and included entities considered very rare. Even for the most prevalent diagnoses, this biopsy technique allowed a more targeted approach resulting in a higher diagnostic yield and justification for more aggressive treatment.
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