Mellgren S I, Lindal S
Neuromuscular Research Group, Department of Clinical Medicine and Department of Medical Biology, University of Tromsø, Tromsø, Norway.
Acta Neurol Scand Suppl. 2011(191):64-70. doi: 10.1111/j.1600-0404.2011.01546.x.
Nerve biopsy is most often a final step in the evaluation of patients with peripheral neuropathy. The procedure should always be expected to result in varying degree of sensory loss within the innervation area of the biopsied nerve and chronic pain in the area may also occur. Therefore appropriate informed consent must be obtained and a weighing of such side effects and benefits for the patient, particularly therapeutical consequences, should be seriously considered before the procedure is performed. The surgical procedure and the processing in the laboratory of the nerve material must hold a high standard at all levels. Nerve biopsy should not be performed before adequate clinical, electrophysiological and laboratory investigations have been performed. The choice of nerve is important, but in most instances the sural nerve is biopsied, although the superficial peroneal nerve is also an option and allows an easy access to muscle biopsy in the same procedure. Laboratories performing nerve biopsies should have the facilities and expertise to prepare and evaluate fixed and frozen sections (paraffin, cryostat and epoxy-sections) and teased fibers, and also to perform light and electron microscopy and immunohistochemistry. Although not routinely used, the option of morphometry should be available as well. We recommend that properly trained technicians start the processing procedures in the operating room and, if feasible, even in hospitals outside that of the hospital with nerve laboratory. We also prefer routine use of teased fiber analysis as this visualizes in an excellent way pathological processes like axonal degeneration, demyelination and remyelination as well as other features. Evaluation of small fiber neuropathy is rarely an indication for nerve biopsy and should be investigated with skin biopsy and visualization and quantification of intraepidermal nerve fibers. Investigation of inflammatory neuropathy, particularly to demonstrate nerve vasculitis, is the main indication of nerve biopsy.
神经活检通常是评估周围神经病变患者的最后一步。该操作往往会导致活检神经支配区域内出现不同程度的感觉丧失，该区域还可能出现慢性疼痛。因此，必须获得适当的知情同意，并且在进行该操作之前，应认真权衡此类副作用和对患者的益处，尤其是治疗后果。手术操作以及神经材料在实验室的处理必须在各个层面保持高标准。在进行充分的临床、电生理和实验室检查之前，不应进行神经活检。神经的选择很重要，但在大多数情况下，活检的是腓肠神经，不过腓浅神经也是一种选择，并且在同一操作中便于进行肌肉活检。进行神经活检的实验室应具备制备和评估固定及冰冻切片（石蜡切片、低温恒温切片和环氧树脂切片）以及 teased 纤维的设施和专业知识，还应具备进行光镜和电镜检查以及免疫组织化学检查的能力。尽管并非常规使用，但形态测量法也应具备。我们建议由经过适当培训的技术人员在手术室启动处理程序，若可行，甚至在设有神经实验室的医院以外的其他医院也可进行。我们还倾向于常规使用 teased 纤维分析，因为它能很好地显示轴突变性、脱髓鞘和再髓鞘化等病理过程以及其他特征。小纤维神经病变的评估很少是神经活检的指征，应通过皮肤活检以及表皮内神经纤维的可视化和定量分析来进行研究。炎症性神经病变的检查，尤其是为了证明神经血管炎，是神经活检的主要指征。
