Imagine you have been struggling with growing weakness in your legs and your doctors have been unable to tell you why. You have had many tests and visits to the top doctors in your area, but still, no answers.
Dr. Winfree says that in a case like this, the next step is often to perform a motor nerve biopsy. The sample can then be sent to the lab to look for motor neuron diseases, like amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig disease, or primary lateral sclerosis (PLS).
With motor neuron diseases, nerve cells in the brain and spinal cord that control your muscles have become diseased and degenerate. Over time, this can cause muscles throughout the body to become weak, resulting in a loss of function like the ability to walk, speak or breathe.
When motor neuron disease is suspected, a biopsy of a motor nerve can be performed to confirm the diagnosis. Most nerves in the body are either sensory nerves or mixed motor and sensory nerves. Only a few contain only motor nerve fibers, and even fewer are surgically accessible and when harvested for the biopsy, do not result in additional weakness.
The most common motor nerve biopsy performed is of the motor branch to the gracilis muscle. To perform this biopsy, a surgeon makes an incision in the upper thigh and takes a small sample of the motor branch to the gracilis muscle off of the nearby obturator nerve. In some cases, accessing the muscle and nerve can be challenging because they are located deep in the thigh. Also, this is not a surgical approach familiar to most neurosurgeons.
Dr. Winfree, who specializes in nerve and muscle biopsies, has developed an alternative approach that makes achieving a motor nerve biopsy easier. “We adapted a surgical approach, familiar to most neurosurgeons, to allow sampling of a pure motor nerve without causing any new weakness. This can help confirm the diagnosis of a suspected motor neuron disease,” says Dr. Winfree.
Their approach uses the motor branch to the peroneus longus muscle, a muscle on the outside of the lower leg, which arises from the nearby peroneal nerve. This nerve branch is typically seen during a routine peroneal nerve decompression procedure. The low-risk procedure can be easily learned by neurosurgeons.
Dr. Winfree presented this adapted technique and patient cases recently in an article in the journal, World Neurosurgery. Each of the patients received effective treatment and recovered from surgery without complications. To learn more, read the full article here.
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