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Nerve Biopsies - Frequently Asked Questions

How is nerve tissue studied at Johns Hopkins?

Nerve tissue obtained at biopsy is studied in great detail at Johns Hopkins. Frozen sections of nerve tissue are routinely prepared with the following stains:

  • H&E
  • Acid phosphatase
  • Gomori trichrome
  • Congo red

Paraffin-embedded sections stained with H&E are also routinely prepared. The principle analysis is performed on nerve tissue embedded in plastic. This procedure, while definitive, requires 3 to 4 weeks to be completed. Additional nerve tissue is routinely archived for future analyses.

Where are the biopsies performed?

Surgeons at any hospital or surgical facility who are familiar with diagnostic nerve biopsy procedures can obtain a specimen, which should then be sent directly to the Neuromuscular Pathology Laboratory for staining and interpretation. 

Biopsies can also be performed at the Johns Hopkins Outpatient Center and for inpatients at The Johns Hopkins Hospital. Patients can expect to spend one half day or more at the outpatient center in preparation and follow-up for the procedure. The tissues obtained at the time of biopsy are prepared in the Neuromuscular Pathology Laboratory at Johns Hopkins.

What is the nerve biopsy procedure?

Because it is an invasive procedure, nerve biopsy is appropriate for the diagnosis of serious nerve disease. Possible diseases which require assessment by nerve biopsy may include vasculitis, amyloid and neuropathy. Inflammatory disease of the nerve can be diagnosed by biopsy and it is often important to firmly establish diagnosis before initiating certain medical regimens. Nerve biopsy is performed under local anesthesia and is an outpatient procedure. Typically completed in one to two hours, patients can expect to spend one half day or more at the outpatient center in preparation and follow-up for the procedure.

What do patients need to do before the procedure?

Patients undergoing nerve or muscle biopsy will receive instructions in advance.

Patients should not take aspirin, aspirin containing products, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for 10 days prior to the procedure.
Patients taking Coumadin, Lovenox, Plavix or Ticlid will need to follow specific instructions relating to these medications. 

What happens after the biopsy?

Patients who have a nerve biopsy in the leg must expect to use crutches or another assistive device for two full days after biopsy. Training with crutches is provided. Stitches do not need to be removed but must remain completely dry for two days.

Staples, when used, will require professional removal 21 or 28 days after the biopsy. In general there are few complications and the resulting scar heals well. Removal of the nerve at biopsy can result in a small numb patch which may resolve over time.

Who interprets the results?

The results of pathological studies are interpreted by designated neuromuscular specialists in the Johns Hopkins Department of Neurology.

When will results be received?

After the biopsy, a report on frozen or paraffin specimens will be sent to the referring physician, generally within one to two weeks. A report on plastic nerve specimens will be provided in three to four weeks.

Are biopsies covered by insurance?

Our staff will secure a patient’s insurance authorization once the appropriate referral forms have been completed.

Is there a doctor or laboratory technician with whom I can directly communicate?

If you have any questions or concerns, please contact 410-614-4278.

 

Andrea Corse and Michael Polydefkis

Andrea Corse, M.D. (Director of the Neuromuscular Pathology Laboratory), and Michael Polydefkis, M.D.

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