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Sommer C, Carroll AS, Koike H, Katsuno M, Ort N, Sobue G, Vucic S, Spies JM, Doppler K, Kiernan MC. Nerve biopsy in acquired neuropathies. J Peripher Nerv Syst 2021; 26 Suppl 2:S21-S41. [PMID: 34523188 DOI: 10.1111/jns.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Antonia S Carroll
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology and Neurophysiology, St Vincent's Hospital, The University of NSW, Sydney, New South Wales, Australia
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nora Ort
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
| | - Steve Vucic
- Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judith M Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
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Uerschels AK, Krogias C, Junker A, Sure U, Wrede KH, Gembruch O. Modern treatment of perineuriomas: a case-series and systematic review. BMC Neurol 2020; 20:55. [PMID: 32054523 PMCID: PMC7017529 DOI: 10.1186/s12883-020-01637-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Perineuriomas are rare benign peripheral nerve sheath tumours of perineurial cell origin and can be classified into intraneural and extraneural perineuriomas. They most commonly present a mononeuropathy of gradual onset and slow progression, resulting in progressive neurological deficits like hypoesthesia or motor weakness. Therapy is still variable. Aim of the study was to compare our surgical treatment and our follow-up regime including high-resolution nerve sonography with the current literature to evaluate best treatment of perineuriomas. Methods Retrospective analysis of our dataset “peripheral nerve lesion” to identify patients suffering from perineuriomas between 01.01.2012 until 31.12.2018. Surgical treatment and the follow-up examination of three patients were described. Additionally, a systematic review including PubMed, the Cochrane Collaboration Library, Scopus and Google Scholar was performed for literature published between January 1, 1990 and October 31, 2019 independently by 2 authors. Results In the first case, the left ulnar nerve was affected. In the second case, the left peroneal nerve and in the third case the right median nerve was affected. High-resolution nerve sonography was performed in each case. All patients underwent interfascicular neurolysis combined with a targeted fascicular biopsy under electrophysiological monitoring. Neurological deficits improved subsidized by rehabilitation. Surgical therapy and the neurological outcome were compared with literature. Systematic review revealed 22 articles, which met the inclusion criteria. Therefore, demographics, surgical treatment and neurological outcome of 77 patients were analysed. Conclusions Perineuriomas are rare benign nerve sheath tumours with a slow progression, sometimes difficult to diagnose. Decompression and neurolysis may improve neurological deficits. High resolution nerve sonography might serve as a helpful additional diagnostic tool in this process.
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Affiliation(s)
- Anne-Kathrin Uerschels
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Andreas Junker
- Department of Neuropathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Alkhaili J, Cambon-Binder A, Belkheyar Z. Intraneural perineurioma: a retrospective study of 19 patients. Pan Afr Med J 2019; 30:275. [PMID: 30637060 PMCID: PMC6317392 DOI: 10.11604/pamj.2018.30.275.16072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/06/2018] [Indexed: 11/20/2022] Open
Abstract
Intraneural perineurioma is a benign neoplasm of peripheral nerve sheath with perineurial cell origin that typically affects teenagers and young adults and tends to result in a motor-predominant neuropathy. The aim of our study is to present the epidemiology, clinical presentation, way of diagnosis and management plan in a consecutive patient series. Ninteen patients diagnosed as having intraneural perineurioma were retrospectively chart reviewed. Diagnosis was done by MRI and/or biopsy with morphological, immunohistochemical staining study confirmation. Patients assessments included gender, age, symptoms, tumor localization, radiological aspect, management and pathological confirmation.Sex ratio was 10 males to 9 females with mean age of 31.2 (15-64). All the patients presented with motor deficit, ten with sensory deficit. Upper limb was involved in 11 cases (among them 4 lesions of brachial plexus), the lower limb in 8 cases. On magnetic resonance imaging, 16 patients showed a nerve enlargement whereas 5 presented with atypical fusiform tumor. Eighteen patients were operated for excision biopsy and/or palliative treatment for their motor deficit. Anatomopathological analysis confirmed the diagnosis in seventeen cases with a morphological pseudo-onion bulb shape and/or specific immunohistochemical assay. One patient had only palliative treatment without excision biopsy. Our data confirmed the equal penetration of intraneural perineurioma to both sex and affected limb. Because of the benignity of the tumor, the surgical treatment focused on optimizing the functional outcome. A prospective study with long term follow-up is required for this under-diagnosed tumor.
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Affiliation(s)
- Jaber Alkhaili
- Department of Orthopaedic Surgery, Bichat Claude Bernard Hospital, Paris, France
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Intraneural perineurioma of the sciatic nerve: an under-recognized nerve neoplasm with characteristic MRI findings. Skeletal Radiol 2014; 43:375-9. [PMID: 24061494 DOI: 10.1007/s00256-013-1733-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/29/2013] [Accepted: 08/30/2013] [Indexed: 02/02/2023]
Abstract
Intraneural perineurioma is a benign peripheral nerve neoplasm that typically affects teenagers and young adults and tends to result in a motor-predominant neuropathy. The lesion is rare, but has likely been underdiagnosed due to a lack of familiarity among both clinicians and radiologists. There have been few reports in the radiology literature despite the lesion having a fairly characteristic imaging appearance. We report a case of a 26-year-old woman with an intraneural perineurioma of the left sciatic nerve confirmed with excisional biopsy and pathologic analysis.
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Roux A, Tréguier C, Bruneau B, Marin F, Riffaud L, Violas P, Michel A, Gandon Y, Gauvrit JY. Localized hypertrophic neuropathy of the sciatic nerve in children: MRI findings. Pediatr Radiol 2012; 42:952-8. [PMID: 22832864 DOI: 10.1007/s00247-012-2418-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/31/2012] [Accepted: 02/12/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND Localized hypertrophic neuropathy (LHN) of the sciatic nerve in children is a rare condition characterized by a painless neurological deficit in the sciatic nerve territory. OBJECTIVE To demonstrate the role of MRI using a specific protocol and describe the primary findings in LHN. MATERIALS AND METHODS Imaging in four children (age 2 years to 12 years) is presented. All children presented with lower limb asymmetry. Three had a steppage gait. LHN was confirmed by electrophysiological studies and by MRI of the whole sciatic nerve with a dedicated protocol covering the lumbar spine and the lower limb. RESULTS There were four direct MRI findings: (1) linear and focal hypertrophy with progressive enlargement of a peripheral nerve or plexus diameter, (2) abnormal hyperintensity of the nerve on T2-weighted images, (3) preserved fascicular configuration, and (4) variable enhancement after intravenous gadolinium administration. In addition there were atrophy and fatty infiltration of innervated muscles. MRI was helpful for determining the extent of lesions and in excluding peripheral nerve compression or tumour. CONCLUSION MRI of the whole sciatic nerve is the method of choice for diagnosing LHN of the sciatic nerve.
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Affiliation(s)
- Adrien Roux
- Department of Radiology, Hopital Sud, University Hospital, 16 Boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
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Norris B, Gonzales M, Drummond KJ. Solitary localised hypertrophic neuropathy of the cauda equina. J Clin Neurosci 2011; 18:712-4. [PMID: 21345679 DOI: 10.1016/j.jocn.2010.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 08/17/2010] [Indexed: 12/31/2022]
Abstract
Localised hypertrophic neuropathy (LHN) is an uncommon non-neoplastic lesion, which is rare in the central nervous system. We report a patient with LHN of the cauda equina. Pre-operatively these lesions cannot be differentiated from schwannoma or other benign tumours or expansions of the nerve roots. Treatment is generally surgical, largely to confirm the diagnosis, and examination of the surgical specimen reveals an expansion of the nerve by "onion bulb" whorls of Schwann cells (S-100 positive). Multiple lesions may be associated with the generalised diffuse hypertrophic neuropathies or chronic inflammatory demyelinating polyneuropathies. It should be differentiated from intraneural perineuroma, which has a similar appearance but comprises perineural cells (epithelial membrane antigen positive). Adjuvant therapy is not required.
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Affiliation(s)
- Briony Norris
- Department of Neurosurgery, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Sachanandani NS, Brown JM, Zaidman C, Brown SS, Mackinnon SE. Intraneural perineurioma of the median nerve: case report and literature review. Hand (N Y) 2010; 5:286-93. [PMID: 19876692 PMCID: PMC2920385 DOI: 10.1007/s11552-009-9228-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 09/23/2009] [Indexed: 01/25/2023]
Abstract
Intraneural perineurioma is a benign peripheral nerve sheath tumor of perineurial cell origin. We present the case of an intraneural perineurioma of the median nerve in a 23-year-old woman which posed a diagnostic challenge. Ultrasonography was found to be a quick, easy, and effective screening tool for identifying the source of the deficit followed by MRI to further elucidate the lesion. We discuss surgical management options for optimizing functional outcomes when addressing such lesions.
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Affiliation(s)
- Neil S. Sachanandani
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Justin M. Brown
- Department of Neurosurgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8057 St. Louis, MO 63110 USA ,Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
| | - Craig Zaidman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO USA
| | - Stephanie S. Brown
- Department of Pathology, Washington University School of Medicine, St. Louis, MO USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO USA
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Localised hypertrophic mononeuropathy (LHM) as a complication of peripheral nerve decompression surgery. Clin Neurol Neurosurg 2010; 112:921-3. [PMID: 20728985 DOI: 10.1016/j.clineuro.2010.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 07/14/2010] [Accepted: 07/16/2010] [Indexed: 11/23/2022]
Abstract
Localised hypertrophic mononeuropathy is the progressive enlargement of a large peripheral nerve, which can lead to profound loss of function. In this case report, we describe the postoperative occurrence of this phenomenon and possible ways to monitor for this condition.
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MRI neurography and diffusion tensor imaging of a sciatic perineuroma in a child. Pediatr Radiol 2008; 38:1009-12. [PMID: 18581107 DOI: 10.1007/s00247-008-0899-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 01/28/2008] [Accepted: 04/26/2008] [Indexed: 10/21/2022]
Abstract
Perineuroma, rare in children, presents as a painless mononeuropathy of a major nerve trunk. Resection of the lesion with end-to-end sural nerve grafting appears to be the treatment of choice. This technique is not recommended if the unhealthy segment of nerve is too long or if spinal roots are involved. However, in children, reports of direct MR evaluation of nerve trunks and of the exiting nerve roots are limited. We report a 7-year-old girl with an intramural sciatic nerve perineuroma in whom the diagnosis was made by MRI and confirmed by biopsy. The MR protocol combining 3-D T2-W STIR SPACE, fat-saturated gadolinium-enhanced T1-W images, and diffusion tensor imaging with tractography was a valuable tool for depicting peripheral nerve and roots in order to plan surgical treatment.
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