Technically successful ultrasound-guided percutaneous sural nerve needle biopsy in a patient with indeterminate peripheral neuropathy

Objective To determine whether ultrasound-guided percutaneous sural nerve needle biopsy yields sufficient tissue for analysis in a patient with suspected vasculitis-related peripheral neuropathy. Materials and methods With real-time ultrasound guidance, a hydrodissection of the sural nerve from the adjacent small saphenous vein was first performed. A 14-gauge biopsy needle was then manipulated under real-time ultrasound guidance to obtain two transverse samples of the sural nerve at the lateral distal calf. Results The biopsy was technically successful and yielded adequate tissue for routine processing. The specimen showed mild epineurial perivascular chronic inflammation with marked loss of myelinated axons. These histologic findings are not diagnostically definitive for vasculitis-related peripheral neuropathy but were supportive of the diagnosis in combination with the patient’s physical examination, laboratory, and electromyography findings. The patient suffered no immediate complications after the procedure. Conclusions This ultrasound-guided sural nerve needle biopsy, like many surgical biopsies, did not yield a definitive result in a patient with suspected vasculitis-related peripheral neuropathy; however, the procedure was technically successful. Given that percutaneous needle procedures offer many advantages over surgical procedures, we believe that this procedure warrants further investigation.