Nerve Biopsies/neuromuscular

[rockydoc]

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Hey,

Im a 2nd year med student interested in neurology.

I have some quick questions.

who does nerve biopsies? Do neuromuscular trained neurologists do them? Or neurosurgery? Or both?

also, what is the procedure like?

thanks,

 

[Raygun77]

at my hospital neurosurgeons (or medical students rotating through) do the nerve biopsies. The path report is then forwarded to the neurologist.

I haven't done one, but my understanding is it is done under local (plus sedation perhaps) and is a simple excisional biopsy.

 

[danielmd06]

Neurologists can do these if they want.

 

[rockydoc]

Neurologists can do these if they want.

So is that privelege reserved for neuromuscular strained guys? Is that just not very common for neurologists to take on biopsies even though they can technically perform them? Seems like it could be an interesting and fun little procedure to work into such a cognition heavy specialty.

 

[danielmd06]

So is that privelege reserved for neuromuscular strained guys? Is that just not very common for neurologists to take on biopsies even though they can technically perform them? Seems like it could be an interesting and fun little procedure to work into such a cognition heavy specialty.

I don't rightly know the answer to this. In my defense, I try to avoid neuromuscular medicine like the plague. Except for ortho-related sports stuff.

I know of just a couple of guys who advertise doing this procedure, and both are neuromuscular fellowship-trained people. Otherwise, as someone said above...this is done by general surgeons or neurosurgeons.

I would suspect that it could be done by any neurologist in the office (usually, these are just office-based biopsies with local anesthesia...like a spinal tap) but the rate limiting factor is actually wanting to do it. If I were you, I would check with the local neuromuscular guy, or surf some websites for big, famous NM programs.

Clearly, something requiring general anesthesia is out of the typical purview of a neurologist.

Good luck!

 

[aaddnl]

So is that privelege reserved for neuromuscular strained guys? Is that just not very common for neurologists to take on biopsies even though they can technically perform them? Seems like it could be an interesting and fun little procedure to work into such a cognition heavy specialty.

Yes, generally the neurologists that do nerve biopsies are Neuromuscular fellowship trained. Surgeons also do them. But, it's not really a procedure to "work in" to your specialty. They are not performed nearly as often as in the past; not very frequently at all in most places. That's because they are often not extremely useful and EMG/NCS , genetic and other blood tests, and the clinical picture typically generates more useful information. I dont know of anyone that goes around routinely doing nerve biopsies to work in as an extra procedure. Some neuromuscular ppl I know don't do them at all or very rarely, only in some vasculitis cases and even then do not require them if the dx is clear based on labs, electrodiagnostics, and clinical picture.
Now, some Neuromuscular trained folks do a fair number of muscle biopsies, but this does require extensive training and can carry some significant risks. They are most frequently done by General Surgeons.

If you are looking for procedures to work in to a "cognition" heavy specialty, there are several procedures neurologists do: EMG/NCS, sleep, botox injections, lumbar punctures, EEG, and several others if you include pain and Neuro-ICU procedures.

 

[typhoonegator]

Depending on what you're looking for, the handling of a muscle biopsy specimen can have a big impact on the diagnostic utility of the procedure. It isn't that technically difficult, but you want someone doing it who is going to be consistently good.

Also, as with any procedure you take on, you need to be willing to deal with the complications and follow-up. Are you going to remove the sutures? If the patient picks the wound open or lets his dog lick it, are you going to see him back in your clinic to deal with it? I doubt it reimburses very well. Doesn't seem worth it to me.

 

[rockydoc]

Thanks for the informative responses. It makes sense now why it isnt a common procedure and also maybe not such a great thing anyway.

I still like neuro though 🙂