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

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.