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Home > Neurology and Neurosurgery > Centers & Clinics > Neuromuscular Pathology Laboratory > Nerve Biopsies

Protocol for Sending Nerve Biopsy Specimens

Please notify the Neuromuscular Pathology Laboratory two days in advance that a nerve specimen will be arriving. Please contact:
- Christopher Dorsey, Senior Histology Technician:
  410-614-4163 (tele)
  410-283-5090 (pager)
  neuromuscularpathlab@jhmi.edu, or
- Jamal Garrison, Histology Technician:
  410-614-4163 (tele)
  410-283-9467 (pager)
  neuromuscularpathlab@jhmi.edu or
- Andrea Corse, MD, Lab Director:
  410-614-4278 (tele)
  410-283-1944 (pager)
  neuromuscularpathlab@jhmi.edu
A surgeon familiar with a diagnostic nerve biopsy procedure should obtain the specimen. Full thickness nerve approximately 4 cm in length is needed.
The nerve is handled as follows. The nerve is placed on a 3x5 index card by the surgeon or the technician. DO NOT STRETCH THE NERVE. Work on the index card. Cut the nerve into 3 sections as detailed below with a double-edged super stainless blade on the index card.

Section #1
- Cut a 1 cm piece for section #1 and place it on the top left hand corner of the card.
- Cut the card around the nerve and place it face down in a container of 4% paraformaldehyde prepared as follows: For 24 ml total solution (or 2 bottles), pour 12 ml 8% Paraformaldehyde and 12 ml 0.2M Sorensen's Phosphate buffer into a graduated cylinder.
- Mix well by placing parafilm over top of cylinder and inverting several times.
- Pour 13 ml of this solution into a biopsy fixative bottle and label as 4% Paraformaldehyde.
- Use the remaining 11 ml solution to prepare the 3% glutaraldehyde/4% paraformaldehyde needed below.
Section #2
- Cut a 2 cm piece for section #2 and place it at the bottom of left hand corner of the card.
- Cut #2 into 3 smaller pieces.
- Cut the card around the nerve and place it face down in container marked 3% glutaraldehyde/4% paraformaldehyde prepared as follows: Into the remaining 11 ml of 4% paraformaldehyde solution add .7 ml of 50% Glutaraldehyde.
- Mix well by stirring with a pipet. Pour this solution into a 2nd fixative bottle and label 3%Glutaraldehyde/4%Paraformaldehyde.
Section #3
- Pin one end of the remaining nerve section #3 (1-2 cm) to the index card and freeze it in 2-methylbutane (isopentane) in a metal cup surrounded by dry ice in a rubber bucket.
- Cool the methylbutane in advance by dropping small pieces of dry ice into the methylbutane (see muscle protocol).
- When the nerve segment is thoroughly frozen, pack section #3 in sufficient dry ice and the other sections in regular ice and ship overnight to:
  
  Christopher Dorsey or Jamal Garrison
  The Neuromuscular Pathology Laboratory
  Johns Hopkins Hospital
  600 N. Wolfe Street
  Meyer Building Room 5-119
  Baltimore, MD 21287-7519
  Phone: 410-614-4163
  neuromuscularpathlab@jhmi.edu
The following information will be needed. Tissue samples cannot be processed unless this information is provided with the specimen.
- Patient's name, address, date of birth, and hospital ID number
- Hospital charge number for billing directly to the hospital
- Brief clinical history
- Identification of muscle biopsy site, date, and time
- Name, address, phone and fax # of referring pathologist and attending physicians