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

## TL;DR

This case report describes using ultra-fast digital confocal microscopy during surgery to confirm a successful sural nerve biopsy, reducing diagnostic errors.

## Contribution

The first reported use of ultra-fast real-time digital confocal microscopy to confirm successful sural nerve biopsy intraoperatively.

## Key findings

- Digital confocal microscopy confirmed successful sural nerve biopsy in real-time during surgery.
- This technique may reduce the diagnostic failure rate caused by mistaken sectioning of nearby structures.
- Current literature lacks examples of this technology applied to peripheral nerve biopsies.

## Abstract

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.

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.

We conduct a literature review to determine current practice for the intraoperative confirmation of successful sural nerve biopsy.

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.