Acetylcholinesterase: a histochemical identification of motor and sensory fascicles in human peripheral nerve and its use during operation.

To evaluate the precision of acetylcholinesterase histochemical identification of motor and sensory fascicles, this study presents a systematic observation of human peripheral nerves by Karnovsky and Roots' histochemical method. The results indicate that either of the enzymatic activities of myelinated and unmyelinated fibers was different between motor and sensory fascicles. Fifty-seven percent of the myelinated fibers showed enzymatic activity in the motor fascicles, while none of the myelinated fibers in the sensory fascicles showed enzymatic activity. The unmyelinated fibers showing enzymatic activity in the sensory fascicles were far denser than those in the motor fascicles. Our study demonstrated that the unmyelinated fibers were sympathetic postganglionic unmyelinated fibers. From these results it is concluded that the motor and sensory fascicles may be identified not only according to the enzymatic activities of the myelinated fibers, but also according to the enzymatic activities of the sympathetic postganglionic unmyelinated fibers. An improved histochemical method was suggested for its applicability as a method of intraoperative nerve fascicle identification. Simulated experiments were done on the radial nerves and the median nerves in human cadavers. This improved histochemical process can be completed within 50 minutes and can be used in intraoperative nerve fascicle identification.