PROCEDURE FOR NERVE BIOPSIES

1.  It is recommended that the clinician discuss the case with the neuropathologist before the biopsy is taken. This permits the pathologist to instruct the laboratory if any special procedures are needed for that specimen. Dr. Eun-Sook Cho (telephone: (973) 972-4145) and Dr. Leroy Sharer (telephone: (973) 972-4770) can be contacted for this.

2. The clinician should notify the neuropathology laboratory of the date and time of the biopsy at least one day prior to the procedure. This allows the technologist time to prepare the laboratory to accept the biopsy. In cases that the specimen comes from a patient with a biohazardous condition, the neuropathology laboratory should be so notified.

3. A request form and written clinical history should accompany the specimen. This should include the results of pertinent laboratory findings as well as the name and
telephone number of the physician responsible for the case.

4. Procedures of sural nerve biopsy (as summarized from Asbury, Johnson: Pathology of Peripheral Nerve, W.B. Saunders Co., Philadelphia, 1978, pp. 268-271):
Following an incision just lateral and parallel to the Achilles tendon, the sural nerve trunk should be identified from the accompanying saphenous vein and dissected free of adjacent tissue with minimal handling, tugging or stretching. The nerve consists of several fascicles and has tree like branching compared to the sharp angled branching of the vein. The proximal transection should always be done first to render the distal transection painless. The proximal transection should be performed in such a manner that the proximal nerve stump will retract above the level of the skin incision and will not be involved in the healing of the wound. This will minimize the chance of developing a painful neuroma. A 3-4 cm segment of nerve is sufficient.

5. The biopsied nerve should be wrapped saline moistened gauze and placed in an empty container. Other than electron microscopy, if special investigations, such as frozen section histochemistry and immunofluorescence are indicated, preoperative arrangements should be made with the neuropathologist for special handling.

6. The nerve biopsy container should be clearly labeled (including BIOHAZARD, if applicable), placed in a Styrofoam box with regular ice (NOT DRY ICE)
and immediately delivered to this address:

Neuropathology Laboratory
Medical Science Building, C-525
185 South Orange Avenue
Newark, NJ 07103
Telephone (973) 972-7167

and handed in person to one of the technicians. The specimen should not be kept for regular delivery of surgical specimens since immediate processing is essential. This is very important in the case of nerves since, the quality of fixation greatly decreases if the nerve is not processed immediately.

NOTE:

      Nerve Biopsies should be received between 9:00 a.m. and 2:00 p.m. – Monday through Friday.

BIOHAZARD SPECIMEN

If the specimen is from a patient with any biohazardous condition, this information should be given to our laboratory at the time of service arrangement (see #2 above). The specimen should also be clearly labeled "BIOHAZARD", in red.