Ultra-fast real-time intraoperative diagnostic confirmation of successful sural nerve biopsy using digital confocal microscopy: a case report and review of the literature.

Selbie, J.; Bolton, W.; Culpin, E.; Mathew, R.; Anderson, I.

Ultra-fast real-time intraoperative diagnostic confirmation of successful sural nerve biopsy using digital confocal microscopy: a case report and review of the literature.

All Authors

Selbie, J.

Bolton, W.

Culpin, E.

Mathew, R.

Anderson, I.

LTHT Author

Bolton, William
Culpin, Elizabeth
Mathew, Ryan
Anderson, Ian

LTHT Department

Neurosciences
Neurosurgery

Publication Date

2025

Item Type

Journal Article

Abstract

Introduction: Sural nerve biopsy is a technique used to aid in the diagnosis of peripheral neuropathy. While this is considered a comparatively straightforward neurosurgical procedure, there is a recognised diagnostic 'failure' rate of around 4%, due to mistaken sectioning of the anatomically close and similar macroscopically appearing lesser saphenous vein. Case report: We report a case of suspected peripheral neuropathy, in which ultra-fast real-time digital confocal microscopy was used intraoperatively to rapidly confirm a successful sural nerve biopsy. Literature review: We conduct a literature review to determine current practice for the intraoperative confirmation of successful sural nerve biopsy. Discussion: Real-time confocal microscopy is used primarily for intraoperative tumour applications (in vivo margin assessment, ex vivo biopsy target confirmation). This is the first reported case of ultra-fast real-time digital confocal microscopy being used to confirm a successful sural nerve biopsy.