SINGLE-INCISION COMBINATION BIOPSY (MUSCLE AND NERVE) IN THE DIAGNOSIS OF NEUROMUSCULAR DISEASE IN CHILDREN

The diagnosis of specific neuromuscular diseases in infants and childr en is often suspected clinically and confirmed histologically by muscl e biopsy. In relatively few cases, the differential diagnosis includes hereditary or acquired peripheral neuropathies, and nerve biopsy is r equired for diagnosis. Historically, children who needed both muscle a nd nerve biopsies have had two separate incisions at the thigh (muscle ) and ankle (nerve) to obtain the specimens. A procedure has been deve loped that employs a single incision on the posterior aspect of the ca lf, which allows for simultaneous muscle (soleus or peroneals) and ner ve (sural) biopsies. A retrospective study of 22 patients who underwen t single-incision combination biopsy was performed. Age at time of bio psy ranged from 2 months to 14 years. Adequate specimens for histologi c analysis were obtained in all but one case. Histologic diagnoses wer e made in 32% of the muscle biopsies and 29% of the nerve biopsies. Me an follow-up after biopsy was 3 years 6 months. Potentially significan t complications of nerve biopsy were not seen in this cohort. Single-i ncision combination biopsy is the preferred technique when simultaneou s muscle and nerve biopsies are required. Knowledge of the location of the sural nerve in the calf is essential. This technique is relativel y less invasive than separate muscle and nerve biopsies, allows for th e harvest of adequate muscle and nerve specimens, is minimally morbid, and can be performed on very young infants.