{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:02Z","timestamp":1780736462059,"version":"3.54.1"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Nerve biopsy is useful in the management of neuromuscular disorders and is commonly performed in distal, noncritical cutaneous nerves. In general, these procedures are diagnostic in only 20%\u201350%. In selected cases in which preoperative evaluation points toward a more localized process, targeted biopsy would likely improve diagnostic yield. The authors report their experience with targeted fascicular biopsy of the brachial plexus and provide a description of the operative technique.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n All cases of targeted biopsy of the brachial plexus biopsy performed between 2003 and 2015 were reviewed. Targeted nerve biopsy was performed using a supraclavicular, infraclavicular, or proximal medial arm approach. Demographic data and clinical presentation as well as the details of the procedure, adverse events (temporary or permanent), and final pathological findings were recorded.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Brachial plexus biopsy was performed in 74 patients (47 women and 27 men). The patients' mean age was 57.7 years. All patients had abnormal findings on physical examination, electrodiagnostic studies, and MRI. The overall diagnostic yield of biopsy was 74.3% (n = 55). The most common diagnoses included inflammatory demyelination (19), breast carcinoma (17), neurolymphomatosis (8), and perineurioma (7). There was a 19% complication rate; most of the complications were minor or transient, but 4 patients (5.4%) had increased numbness and 3 (4.0%) had additional weakness following biopsy.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Targeted fascicular biopsy of the brachial plexus is an effective diagnostic procedure, and in highly selected cases should be considered as the initial procedure over nontargeted, distal cutaneous nerve biopsy. Using MRI to guide the location of a fascicular biopsy, the authors found this technique to produce a higher diagnostic yield than historical norms as well as providing justification for definitive treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.1.focus16404","type":"journal-article","created":{"date-parts":[[2017,3,1]],"date-time":"2017-03-01T03:45:39Z","timestamp":1488339939000},"page":"E9","source":"Crossref","is-referenced-by-count":20,"title":["Targeted fascicular biopsy of the brachial plexus: rationale and operative technique"],"prefix":"10.3171","volume":"42","author":[{"given":"Pierre","family":"Laumonerie","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, H\u00f4pital Pierre Paul Riquet, Toulouse, France;\u00a0"},{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stepan","family":"Capek","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly K.","family":"Amrami","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. James B.","family":"Dyck","sequence":"additional","affiliation":[{"name":"Neurology, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Departments of Neurologic Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16404","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 MK,","year":"1997","unstructured":"Abouzahr MK, Lange DJ, Latov N, Olarte M, Rowland LP, Hays AP, : Diagnostic biopsy of the motor nerve to the gracilis muscle. Technical note. J Neurosurg 87:122\u2013124, 1997"},{"key":"b2-focus16404","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 JB,","year":"2012","unstructured":"Agadi JB, Raghav G, Mahadevan A, Shankar SK: Usefulness of superficial peroneal nerve\/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy. J Clin Neurosci 19:1392\u20131396, 2012"},{"key":"b3-focus16404","series-title":"Neurosurg Clin N Am","first-page":"559","article-title":"MRI of peripheral nerves","volume":"19","author":"Amrami KK,","year":"2008","unstructured":"Amrami KK, Felmlee JP, Spinner RJ: MRI of peripheral nerves. Neurosurg Clin N Am 19:559\u2013572, vi, 2008"},{"key":"b4-focus16404","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"15","article-title":"Techniques for magnetic resonance imaging of peripheral nerves: diagnosis and guidance for targeted fascicular nerve biopsy","author":"Amrami KK,","year":"2010","unstructured":"Amrami KK, Spinner RJ, Dyck PJB, Felmlee JP, Techniques for magnetic resonance imaging of peripheral nerves: diagnosis and guidance for targeted fascicular nerve biopsy. Dyck PJ, Amrami KK, Klein CJ, : Companion to Peripheral Neuropathy: Illustrated Cases and New Developments Philadelphia, Saunders Elsevier, 2010. 15\u201318"},{"issue":"3","key":"b5-focus16404","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique","volume":"39","author":"Capek S,","year":"2015","unstructured":"Capek S, Amrami KK, Dyck PJB, Spinner RJ: Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique. Neurosurg Focus 39:3E12, 2015"},{"key":"b6-focus16404","series-title":"Skeletal Radiol","first-page":"1001","article-title":"Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association","volume":"44","author":"Capek S,","year":"2015","unstructured":"Capek S, H\u00e9bert-Blouin MN, Puffer RC, Martinoli C, Frick MA, Amrami KK, : Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association. Skeletal Radiol 44:1001\u20131009, 2015"},{"key":"b7-focus16404","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 CJ,","year":"2012","unstructured":"Dy CJ, Lange DJ, Jones KJ, Garg R, DiCarlo EF, Wolfe SW: Diagnostic biopsy of the pronator teres and a motor branch of the median nerve: indications and technique. J Hand Surg Am 37:2570\u20132575, 2012"},{"key":"b8-focus16404","series-title":"Med Clin North Am","first-page":"885","article-title":"Nerve biopsy. Choice of nerve, method, symptoms, and usefulness","volume":"52","author":"Dyck PJ,","year":"1968","unstructured":"Dyck PJ, Lofgren EP: Nerve biopsy. Choice of nerve, method, symptoms, and usefulness. Med Clin North Am 52:885\u2013893, 1968"},{"key":"b9-focus16404","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 PJB,","year":"2010","unstructured":"Dyck PJB, Spinner RJ, Amrami KK, Klein CJ, Engelstad JK, Dyck PJ, MRI-targeted fascicular nerve biopsies of proximal nerves: historic reports and illustrative case reports. Dyck PJ, Amrami KK, Klein CJ, : Companion to Peripheral Neuropathy: Illustrated Cases and New Developments Philadelphia, Saunders Elsevier, 2010. 3\u201314"},{"key":"b10-focus16404","series-title":"Br J Neurosurg","first-page":"727","article-title":"Muscle and nerve biopsy for the neurosurgical trainee","volume":"27","author":"Hart MG,","year":"2013","unstructured":"Hart MG, Santarius T, Trivedi RA: Muscle and nerve biopsy for the neurosurgical trainee. Br J Neurosurg 27:727\u2013734, 2013"},{"key":"b11-focus16404","series-title":"Semin Musculoskelet Radiol","first-page":"160","article-title":"High-resolution imaging of upper limb neuropathies","volume":"19","author":"Howe BM,","year":"2015","unstructured":"Howe BM, Spinner RJ, Felmlee JP, Amrami KK: High-resolution imaging of upper limb neuropathies. 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Skeletal Radiol 42:567\u2013577, 2013"},{"key":"b16-focus16404","series-title":"Chir Main","first-page":"1","article-title":"Nerve transfers in brachial plexus palsies","volume":"28","author":"Oberlin C,","year":"2009","unstructured":"Oberlin C, Durand S, Belheyar Z, Shafi M, David E, Asfazadourian H: Nerve transfers in brachial plexus palsies. Chir Main 28:1\u20139, 2009"},{"key":"b17-focus16404","series-title":"Yonsei Med J","first-page":"1","article-title":"Diagnostic usefulness and limitations of the sural nerve biopsy","volume":"31","author":"Oh SJ:","year":"1990","unstructured":"Oh SJ: Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J 31:1\u201326, 1990"},{"key":"b18-focus16404","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 A,","year":"2005","unstructured":"Ruth A, Schulmeyer FJ, Roesch M, Woertgen C, Brawanski A: Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy. Clin Neurol Neurosurg 107:214\u2013217, 2005"},{"key":"b19-focus16404","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"19","article-title":"Targeted fascicular biopsy: a surgical perspective","author":"Spinner RJ,","year":"2010","unstructured":"Spinner RJ, Amrami KK, Dyck PJB, Targeted fascicular biopsy: a surgical perspective. Dyck PJ, Amrami KK, Klein CJ, : Companion to Peripheral Neuropathy: Illustrated Cases and New Developments Philadelphia, Saunders Elsevier, 2010. 19\u201324"},{"key":"b1-focus16404","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 MK,","year":"1997","unstructured":"Abouzahr MK, Lange DJ, Latov N, Olarte M, Rowland LP, Hays AP, : Diagnostic biopsy of the motor nerve to the gracilis muscle. Technical note. J Neurosurg 87:122\u2013124, 1997"},{"key":"b2-focus16404","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 JB,","year":"2012","unstructured":"Agadi JB, Raghav G, Mahadevan A, Shankar SK: Usefulness of superficial peroneal nerve\/peroneus brevis muscle biopsy in the diagnosis of vasculitic neuropathy. J Clin Neurosci 19:1392\u20131396, 2012"},{"key":"b3-focus16404","series-title":"Neurosurg Clin N Am","first-page":"559","article-title":"MRI of peripheral nerves","volume":"19","author":"Amrami KK,","year":"2008","unstructured":"Amrami KK, Felmlee JP, Spinner RJ: MRI of peripheral nerves. Neurosurg Clin N Am 19:559\u2013572, vi, 2008"},{"key":"b4-focus16404","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"15","article-title":"Techniques for magnetic resonance imaging of peripheral nerves: diagnosis and guidance for targeted fascicular nerve biopsy","author":"Amrami KK,","year":"2010","unstructured":"Amrami KK, Spinner RJ, Dyck PJB, Felmlee JP, Techniques for magnetic resonance imaging of peripheral nerves: diagnosis and guidance for targeted fascicular nerve biopsy. Dyck PJ, Amrami KK, Klein CJ, : Companion to Peripheral Neuropathy: Illustrated Cases and New Developments Philadelphia, Saunders Elsevier, 2010. 15\u201318"},{"issue":"3","key":"b5-focus16404","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique","volume":"39","author":"Capek S,","year":"2015","unstructured":"Capek S, Amrami KK, Dyck PJB, Spinner RJ: Targeted fascicular biopsy of the sciatic nerve and its major branches: rationale and operative technique. 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J Hand Surg Am 37:2570\u20132575, 2012"},{"key":"b8-focus16404","series-title":"Med Clin North Am","first-page":"885","article-title":"Nerve biopsy. Choice of nerve, method, symptoms, and usefulness","volume":"52","author":"Dyck PJ,","year":"1968","unstructured":"Dyck PJ, Lofgren EP: Nerve biopsy. Choice of nerve, method, symptoms, and usefulness. Med Clin North Am 52:885\u2013893, 1968"},{"key":"b9-focus16404","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 PJB,","year":"2010","unstructured":"Dyck PJB, Spinner RJ, Amrami KK, Klein CJ, Engelstad JK, Dyck PJ, MRI-targeted fascicular nerve biopsies of proximal nerves: historic reports and illustrative case reports. 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Skeletal Radiol 42:567\u2013577, 2013"},{"key":"b16-focus16404","series-title":"Chir Main","first-page":"1","article-title":"Nerve transfers in brachial plexus palsies","volume":"28","author":"Oberlin C,","year":"2009","unstructured":"Oberlin C, Durand S, Belheyar Z, Shafi M, David E, Asfazadourian H: Nerve transfers in brachial plexus palsies. Chir Main 28:1\u20139, 2009"},{"key":"b17-focus16404","series-title":"Yonsei Med J","first-page":"1","article-title":"Diagnostic usefulness and limitations of the sural nerve biopsy","volume":"31","author":"Oh SJ:","year":"1990","unstructured":"Oh SJ: Diagnostic usefulness and limitations of the sural nerve biopsy. Yonsei Med J 31:1\u201326, 1990"},{"key":"b18-focus16404","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 A,","year":"2005","unstructured":"Ruth A, Schulmeyer FJ, Roesch M, Woertgen C, Brawanski A: Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy. Clin Neurol Neurosurg 107:214\u2013217, 2005"},{"key":"b19-focus16404","series-title":"Companion to Peripheral Neuropathy: Illustrated Cases and New Developments","first-page":"19","article-title":"Targeted fascicular biopsy: a surgical perspective","author":"Spinner RJ,","year":"2010","unstructured":"Spinner RJ, Amrami KK, Dyck PJB, Targeted fascicular biopsy: a surgical perspective. 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