{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T03:39:06Z","timestamp":1778297946154,"version":"3.51.4"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,9]]},"abstract":"\n OBJECT<\/jats:title>\n Nerve biopsy is typically performed in distal, noncritical sensory nerves without using imaging to target the more involved regions. The yield of these procedures rarely achieves more than 50%. In selected cases where preoperative evaluation points toward 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 biopsy of a portion of the major mixed nerves safely and efficiently. Herein, experiences with the sciatic nerve are reported and a description of the operative technique is provided.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n All cases of sciatic nerve biopsy performed between 2000 and 2014 were reviewed. Only cases of fascicular nerve biopsy approached from the buttock or the posterior aspect of the thigh were included. Demographic data, clinical presentation, and the presence of percussion tenderness for each patient were recorded. Reviewed studies included electrodiagnostic tests and 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.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n One hundred twelve cases (63 men and 49 women) of sciatic nerve biopsy were performed. Mean patient age was 46.4 years. Seventy-seven (68.8%) patients presented with single lower-extremity symptoms, 16 (14.3%) with bilateral lower-extremity symptoms, and 19 (17%) with generalized symptoms. No patient had normal findings on physical examination. All patients underwent electrodiagnostic studies, the findings of which were abnormal in 110 (98.2%) patients. MRI was available for all patients and was read as pathological in 111 (99.1%). The overall diagnostic yield of biopsy was 84.8% (n = 95). The pathological diagnoses included inflammatory demyelination, perineurioma, nonspecific inflammatory changes, neurolymphomatosis, amyloidosis, prostate cancer, injury neuroma, neuromuscular choristoma, sarcoidosis, vasculitis, hemangiomatosis, arteriovenous malformation, fibrolipomatous hamartoma (lipomatosis of nerve), and cervical adenocarcinoma. The series included 11 (9.9%) temporary and 5 (4.5%) permanent complications: 3 patients (2.7%) reported permanent numbness in the peroneal division distribution, and 2 patients (1.8%) were diagnosed with neuromuscular choristoma that developed desmoid tumor at the biopsy site 3 and 8 years later.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Targeted fascicular biopsy of the sciatic nerve is a safe and 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 more prevalent diagnoses, the biopsy technique allowed a more targeted approach with a higher diagnostic yield and justification for more aggressive treatment. In this series, new radiological patterns of some entities were identified, which could be biopsied less frequently.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.6.focus15213","type":"journal-article","created":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T03:41:33Z","timestamp":1441078893000},"page":"E12","source":"Crossref","is-referenced-by-count":35,"title":["Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique"],"prefix":"10.3171","volume":"39","author":[{"given":"Stepan","family":"Capek","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery,"},{"name":"International Clinical Research Center, St. Anne\u2019s University Hospital Brno, Brno, Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. James B.","family":"Dyck","sequence":"additional","affiliation":[{"name":"Neurology, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-focus15213","series-title":"J Neurosurg","first-page":"122","article-title":"Diagnostic biopsy of the motor nerve to the gracilis muscle. Technical note","volume":"87","author":"Abouzahr","year":"1997"},{"key":"b2-focus15213","series-title":"J Clin Neurosci","first-page":"1392","article-title":"Usefulness of superficial peroneal nerve\/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy","volume":"19","author":"Agadi","year":"2012"},{"key":"b3-focus15213","series-title":"Neurosurg Clin N Am","first-page":"559","article-title":"MRI of peripheral nerves","volume":"19","author":"Amrami","year":"2008"},{"key":"b4-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"15","article-title":"Techniques for magnetic resonance imaging of peripehral nerves: diagnosis and guidance for targeted fascicular nerve biopsy","author":"Amrami","year":"2010"},{"key":"b5-focus15213","series-title":"Skeletal Radiol","first-page":"1001","article-title":"Tumefactive appearance of peripheral nerve involvement in hematologic malignances: a new imaging association","volume":"44","author":"Capek","year":"2015"},{"key":"b6-focus15213","series-title":"J Hand Surg Am","first-page":"2570","article-title":"Diagnostic biopsy of the pronator teres and a motor branch of the median nerve: indications and technique","volume":"37","author":"Dy","year":"2012"},{"key":"b7-focus15213","series-title":"Mayo Clin Proc","first-page":"778","article-title":"Method of fascicular biopsy of human peripheral nerve for electrophysiologic and histologic study","volume":"41","author":"Dyck","year":"1966"},{"key":"b8-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"3","article-title":"MRI-targeted fascicular nerve biopsies of proximal nerves: historic reports and illustrative case reports","author":"Dyck","year":"2010"},{"key":"b9-focus15213","series-title":"J Neurol Neurosurg Psychiatry","first-page":"442","article-title":"Prospective study of the usefulness of sural nerve biopsy","volume":"69","author":"Gabriel","year":"2000"},{"key":"b10-focus15213","series-title":"Acta Neurochir (Wien)","first-page":"1567","article-title":"Adenocarcinoma of the prostate involving the lumbosacral plexus MRI evidence to support direct perineural spread","volume":"152","author":"H\u00e9bert-Blouin","year":"2010"},{"key":"b11-focus15213","series-title":"J Neurosurg","first-page":"252","article-title":"Addendum: Evidence supports a \u201cno-touch \u201dapproach to neuromuscular choristoma","volume":"119","author":"H\u00e9bert-Blouin","year":"2013"},{"key":"b12-focus15213","series-title":"J Neurosurg","first-page":"399","article-title":"Fibromatosis: a potential sequela of neuromuscular choristoma","volume":"116","author":"H\u00e9bert-Blouin","year":"2012"},{"key":"b13-focus15213","series-title":"Skeletal Radiol","first-page":"1627","article-title":"Perineural spread of cervical cancer to the sciatic nerve","volume":"42","author":"Howe","year":"2013"},{"key":"b14-focus15213","series-title":"Muscle Nerve","first-page":"659","article-title":"Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: an unusual entity","volume":"34","author":"Ladha","year":"2006"},{"key":"b15-focus15213","series-title":"Skeletal Radiol","first-page":"260","article-title":"Fibrolipomatous hamartoma: pathognomonic on MR imaging","volume":"28","author":"Marom","year":"1999"},{"key":"b16-focus15213","series-title":"Brain","first-page":"2265","article-title":"Longitudinal study of intraneural perineurioma-a benign, focal hypertrophic neuropathy of youth","volume":"132","author":"Mauermann","year":"2009"},{"key":"b17-focus15213","series-title":"Skeletal Radiol","first-page":"567","article-title":"Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis","volume":"42","author":"Niederhauser","year":"2013"},{"key":"b18-focus15213","series-title":"Chir Main","first-page":"1","article-title":"Nerve transfers in brachial plexus palsies","volume":"28","author":"Oberlin","year":"2009"},{"key":"b19-focus15213","series-title":"Yonsei Med J","first-page":"1","article-title":"Diagnostic usefulness and limitations of the sural nerve biopsy","volume":"31","author":"Oh","year":"1990"},{"key":"b20-focus15213","series-title":"Stereotact Funct Neurosurg","first-page":"137","article-title":"Current status of stereotactic biopsy","volume":"76","author":"Rajshekhar","year":"2001"},{"key":"b21-focus15213","series-title":"Clin Neurol Neurosurg","first-page":"214","article-title":"Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy","volume":"107","author":"Ruth","year":"2005"},{"key":"b22-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"19","article-title":"Targeted fascicular biopsy: a surgical perspective","author":"Spinner","year":"2010"},{"key":"b1-focus15213","series-title":"J Neurosurg","first-page":"122","article-title":"Diagnostic biopsy of the motor nerve to the gracilis muscle. Technical note","volume":"87","author":"Abouzahr","year":"1997"},{"key":"b2-focus15213","series-title":"J Clin Neurosci","first-page":"1392","article-title":"Usefulness of superficial peroneal nerve\/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy","volume":"19","author":"Agadi","year":"2012"},{"key":"b3-focus15213","series-title":"Neurosurg Clin N Am","first-page":"559","article-title":"MRI of peripheral nerves","volume":"19","author":"Amrami","year":"2008"},{"key":"b4-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"15","article-title":"Techniques for magnetic resonance imaging of peripehral nerves: diagnosis and guidance for targeted fascicular nerve biopsy","author":"Amrami","year":"2010"},{"key":"b5-focus15213","series-title":"Skeletal Radiol","first-page":"1001","article-title":"Tumefactive appearance of peripheral nerve involvement in hematologic malignances: a new imaging association","volume":"44","author":"Capek","year":"2015"},{"key":"b6-focus15213","series-title":"J Hand Surg Am","first-page":"2570","article-title":"Diagnostic biopsy of the pronator teres and a motor branch of the median nerve: indications and technique","volume":"37","author":"Dy","year":"2012"},{"key":"b7-focus15213","series-title":"Mayo Clin Proc","first-page":"778","article-title":"Method of fascicular biopsy of human peripheral nerve for electrophysiologic and histologic study","volume":"41","author":"Dyck","year":"1966"},{"key":"b8-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"3","article-title":"MRI-targeted fascicular nerve biopsies of proximal nerves: historic reports and illustrative case reports","author":"Dyck","year":"2010"},{"key":"b9-focus15213","series-title":"J Neurol Neurosurg Psychiatry","first-page":"442","article-title":"Prospective study of the usefulness of sural nerve biopsy","volume":"69","author":"Gabriel","year":"2000"},{"key":"b10-focus15213","series-title":"Acta Neurochir (Wien)","first-page":"1567","article-title":"Adenocarcinoma of the prostate involving the lumbosacral plexus MRI evidence to support direct perineural spread","volume":"152","author":"H\u00e9bert-Blouin","year":"2010"},{"key":"b11-focus15213","series-title":"J Neurosurg","first-page":"252","article-title":"Addendum: Evidence supports a \u201cno-touch \u201dapproach to neuromuscular choristoma","volume":"119","author":"H\u00e9bert-Blouin","year":"2013"},{"key":"b12-focus15213","series-title":"J Neurosurg","first-page":"399","article-title":"Fibromatosis: a potential sequela of neuromuscular choristoma","volume":"116","author":"H\u00e9bert-Blouin","year":"2012"},{"key":"b13-focus15213","series-title":"Skeletal Radiol","first-page":"1627","article-title":"Perineural spread of cervical cancer to the sciatic nerve","volume":"42","author":"Howe","year":"2013"},{"key":"b14-focus15213","series-title":"Muscle Nerve","first-page":"659","article-title":"Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: an unusual entity","volume":"34","author":"Ladha","year":"2006"},{"key":"b15-focus15213","series-title":"Skeletal Radiol","first-page":"260","article-title":"Fibrolipomatous hamartoma: pathognomonic on MR imaging","volume":"28","author":"Marom","year":"1999"},{"key":"b16-focus15213","series-title":"Brain","first-page":"2265","article-title":"Longitudinal study of intraneural perineurioma-a benign, focal hypertrophic neuropathy of youth","volume":"132","author":"Mauermann","year":"2009"},{"key":"b17-focus15213","series-title":"Skeletal Radiol","first-page":"567","article-title":"Neuromuscular choristoma: characteristic magnetic resonance imaging findings and association with post-biopsy fibromatosis","volume":"42","author":"Niederhauser","year":"2013"},{"key":"b18-focus15213","series-title":"Chir Main","first-page":"1","article-title":"Nerve transfers in brachial plexus palsies","volume":"28","author":"Oberlin","year":"2009"},{"key":"b19-focus15213","series-title":"Yonsei Med J","first-page":"1","article-title":"Diagnostic usefulness and limitations of the sural nerve biopsy","volume":"31","author":"Oh","year":"1990"},{"key":"b20-focus15213","series-title":"Stereotact Funct Neurosurg","first-page":"137","article-title":"Current status of stereotactic biopsy","volume":"76","author":"Rajshekhar","year":"2001"},{"key":"b21-focus15213","series-title":"Clin Neurol Neurosurg","first-page":"214","article-title":"Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy","volume":"107","author":"Ruth","year":"2005"},{"key":"b22-focus15213","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"19","article-title":"Targeted fascicular biopsy: a surgical perspective","author":"Spinner","year":"2010"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/3\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/3\/article-pE12.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/3\/article-pE12.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:23:30Z","timestamp":1775895810000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/3\/article-pE12.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,9]]},"references-count":44,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2015.6.focus15213","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,9]]}}}