Abstract
In this chapter, we review the peripheral nerve anatomy pertinent to interpretation of biopsy material. We discuss the epineurial, perineurial, and endoneurial compartments of nerve, followed by a description of the changes that occur with aging. In subsequent chapters, we will deal with the ultrastructure and pathophysiology of axons, Schwann cells and myelin, the neural vasculature, as well as aspects of quantitative morphometry. Because the sural nerve is almost universally the nerve chosen for biopsy, certain elements of the discussion are specific to this site.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Arnold N, Harriman DGF (1970) The incidence of abnormality in control human peripheral nerves studied by single axon dissection. J Neurol Neurosurg Psychiatry 33:55–61
Beamish NG, Stolinski C, Thomas PK et al (1991) Freeze fracture observations on normal and abnormal human perineurial tight junctions: alterations in diabetic polyneuropathies. Acta Neuropathol 81:269–279
Beggs J, Johnson PC, Olafsen A et al (1991) Transperineurial arterioles in human sural nerve. J Neuropathol Exp Neurol 50:704–718
Behse F (1990) Morphometric studies on the human sural nerve. Acta Neurol Scand 132(Suppl):1–38
Behse F, Buchthal F, Carlsen F, Knappeis GG (1974) Endoneurial space and its constituents in the sural nerve of patients with neuropathy. Brain 97:773–784
Behse F, Buchthal F, Carlsen F, Knappeis GG (1975) Unmyelinated fibres and Schwann cells of sural nerve in neuropathy. Brain 98:493–510
Bell MA, Weddell AGM (1984) A morphometric study of intrafascicular vessels of mammalian sciatic nerve. Muscle Nerve 7:524–534
Bergouignan FX, Vital C (1984) Occurrence of Renaut bodies in a peripheral nerve. Arch Pathol Lab Med 108:330–333
Bonetti B, Monaco S, Giannini C et al (1993) Human peripheral nerve macrophages in normal and pathological reactions. J Neurol Sci 118:158–168
Bouche P, Cattelin F, Saint-Jean O et al (1993) Clinical and electrophysiological study of the peripheral nervous system in the elderly. J Neurol 240:263–268
Brosnan CF, Claudio L, Tansey FA, Martiney J (1990) Mechanisms of autoimmune neuropathies. Ann Neurol 27(Suppl):S75–S79
Bunge MB, Wood PM, Tynan LB et al (1989) Perineurium originates from fibroblasts: demonstration in vitro with a retroviral marker. Science 243:229–231
Carlsen F, Knappeis GG, Behse F (1974) Schwann cell length in unmyelinated fibres of human sural nerve. J Anat 117:463–467
Chad D, Shoukimas GM, Bradley WG et al (1981) Peripheral nerve unmyelinated axons following lumbar sympathectomy. Ann Neurol 10:486–488
Claman HN (1985) Mast cells, T cells, and abnormal fibrosis. Immunol Today 6:192–195
Claman HN (1993) Mast cells and fibrosis. Hints from graft-versus-host disease and scleroderma. In: Kaliner MA, Metcalfe DD (eds) The mast cell in health and disease. Marcel Dekker, New York, pp 653–667
De la Motte DJ, Hall SM, Allt G (1975) A study of the perineurium in peripheral nerve pathology. Acta Neuropathol 33:257–270
De la Monte SM, Gabuzda DH, Ho DD et al (1988) Peripheral neuropathy in the acquired immunodeficiency syndrome. Ann Neurol 23:485–492
Dyck PJ, Giannini C, Lais A (1993) Pathologic alterations of nerves. In: Dyck PJ, Thomas PK et al (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, p 540
Ellis DW (1993) Lymphoproliferative disorders. In: Leong ASY (ed) Applied immunohistochemistry for the surgical pathologist. Edward Arnold, London, pp 124–126
Ferreira JMC, Cladini EG, Montes GS (1987) Distribution of elastic system fibers in the peripheral nerves of mammals. Acta Anat 130:168–173
Ferriere G, Denef JF, Rodriguez J, Guzzetta F (1985) Morphometric studies of normal sural nerves in children. Muscle Nerve 8:697–704
Forsythe P, Bienenstock J (2012) The mast cell- nerve functional unit: a key component of physiologic and pathophysiologic responses. In: Bienenstock J (ed) Allergy and the nervous system, vol 98, Chemical immunology and allergy. Karger, Basel, pp 196–221
Friede RL, Bischhausen R (1978) The organization of endoneurial collagen in peripheral nerves as revealed with the scanning electron microscope. J Neurol Sci 38:83–88
Friede RL, Meier T, Diem M (1981) How is the exact length of an internode determined? J Neurol Sci 50:217–228
Ghadially FN (1988) Ultrastructural pathology of the cell and matrix, 3rd edn. Butterworths, London, pp 1252–1259
Griffin JW, Stoll G, Li CY et al (1990) Macrophage responses in inflammatory demyelinating neuropathies. Ann Neurol 27(Suppl):S64–S68
Griffin JW, George R, Ho T (1993) Macrophage systems in peripheral nerves. A review. J Neuropathol Exp Neurol 52:553–560
Gutrecht JA, Dyck PJ (1970) Quantitative teased fiber and histological studies of human sural nerve during postnatal development. J Comp Neurol 138:117–130
Hall S, Hughes R, Atkinson P (1991) Lamellated sensory corpuscles within the endoneurium. J Neurol Neurosurg Psychiatry 54:744–745
Hann-Bonnekoh PG, Scheidt P, Friede RL (1989) Myelin phagocytosis by peritoneal macrophages in organ cultures of mouse peripheral nerve. A new model for studying myelin phagocytosis in vitro. J Neuropathol Exp Neurol 48:140–153
Honavar M, Tharakan JKJ, Hughes RAC et al (1991) A clinicopathological study of the Guillain-Barre syndrome. Nine cases and literature review. Brain 114:1245–1269
Infante E, Kennedy WR (1970) Anomalous branch of the peroneal nerve detected by electromyography. Arch Neurol 22:162–165
Ito A, Hagiyama M, Oonuma J (2008) Nerve-mast cell and smooth muscle-mast cell interaction mediated by cell adhesion molecule-1, CADM1. J Smooth Muscle Res 44:83–93
Jacobs JM, Love S (1985) Qualitative and quantitative morphology of human sural nerve at different ages. Brain 108:897–924
Jefferson D, Neary D, Eames RA (1981) Renaut body distribution at sites of human peripheral nerve entrapment. J Neurol Sci 49:19–29
Johnson D, Seeldrayers PA, Weiner HL (1988) The role of mast cells in demyelination. 1. Myelin proteins are degraded by mast cell proteases and myelin basic protein and P2 can stimulate mast cell degranulation. Brain Res 444:195–198
Junqueira LCU, Nontes GS, Krisztan RM (1979) The collagen of the vertebrate peripheral nervous system. Cell Tissue Res 202:453–460
Kaliner MA, Metcalfe DD (eds) (1993) The mast cell in health and disease. Marcel Dekker, New York
Kanda T, Tsukagoshi H, Oda M et al (1991) Morphological changes in unmyelinated nerve fibres in the sural nerve with age. Brain 114:585–599
Kerkoff A, Troost D, Louwerse ES et al (1993) Inflammatory cells in the peripheral nervous system in motor neuron disease. Acta Neuropathol 85:560–565
Kimura J (1989) Electrodiagnosis in diseases of nerve and muscle: principles and practice, 2nd edn. FA Davis Company, Philadelphia, pp 95–96
Knorr-Held S, Meier C (1990) Mast cells in human polyneuropathies: their density and regional distribution. Clin Neuropathol 9:121–124
Lambert EH (1969) The accessory deep peroneal nerve: a common variation in innervation of extensor digitorum brevis. Neurology 19:1169–1176
Lascelles RG, Thomas PK (1966) Changes due to age in internodal length in the sural nerve in man. J Neurol Neurosurg Psychiatry 29:40–44
Liguori R, Krarup C, Trojaborg W (1992) Determination of the segmental sensory and motor innervation of the lumbosacral spinal nerves. An electrophysiological study. Brain 115:915–934
Lorimier P, Mezin P, Labat Moleur F et al (1992) Ultrastructural localization of the major components of the extracellular matrix in normal rat nerve. J Histochem Cytochem 40:859–868
Low PA, Marchand G, Knox F, Dyck PJ (1977) Measurement of endoneurial fluid pressure with polyethylene matrix capsules. Brain Res 122:373–377
Low PA, Yao JK, Poduslo JF et al (1982) Peripheral nerve microenvironment: collection of endoneurially enriched fluid. Exp Neurol 77:208–214
Lu J, Chang KL (2011) Practical immunohistochemistry in hematopathology: a review of useful antibodies for diagnosis. Adv Anat Pathol 18:133–151
MacKinnon SE, Dellon AL, Hudson AR, Hunter DA (1986) Chronic human nerve compression – a histological assessment. Neuropathol Appl Neurobiol 12:547–565
Mecham RP, Heuser JE (1991) The elastic fiber. In: Day ED (ed) Cell biology of the extracellular matrix, 2nd edn. Plenum Press, New York, pp 79–109
Meier C, Bischoff A (1977) Polyneuropathy in hypothyroidism. Clinical and nerve biopsy study of 4 cases. J Neurol 215:103–114
Mezei C (1993) Myelination in the peripheral nerve during development. In: Dyck PJ, Thomas PK et al (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, pp 267–281
Müller M, Leonhard C, Krauthausen M (2010) On the longevity of resident endoneurial macrophages in the peripheral nervous system: a study of physiological macrophage turnover in bone marrow chimeric mice. J Peripher Nerv Syst 15:357–365
Müller M, Stenner M, Wacker K et al (2006) Contribution of resident endoneurial macrophages to the local cellular response in experimental autoimmune neuritis. J Neuropathol Exp Neurol 65:499–507
Müller M, Wacker K, Getts D et al (2008) Further evidence for a crucial role of resident endoneurial macrophages in peripheral nerve disorders: lessons from acrylamide-induced neuropathy. Glia 56:1005–1016
Neary D, Ochoa J, Gilliatt RW (1975) Subclinical entrapment neuropathy in man. J Neurol Sci 24:283–298
Nesbitt JA, Acland RD (1980) Histopathological changes following removal of the perineurium. J Neurosurg 53:233–238
Ochoa J (1971) The sural nerve of the human foetus: electron microscope observations and counts of axons. J Anat 108:231–245
Ochoa J, Mair WGP (1969) The normal sural nerve in man. I: ultrastructure and number of fibres and cells. Acta Neuropathol 13:197–216
Olsson Y (1968) Mast cells in the nervous system. Int Rev Cytol 24:27–70
Olsson Y (1971) Mast cells in human peripheral nerve. Acta Neurol Scand 47:357–368
Olsson Y (1990) Microenvironment of the peripheral nervous system under normal and pathological conditions. Crit Rev Neurobiol 5:265–311
Ortiguela ME, Wood MB, Cahill DR (1987) Anatomy of the sural nerve complex. J Hand Surg Am 12:1119–1123
Ortman JA, Sahenk Z, Mendell JR (1983) The experimental production of Renaut bodies. J Neurol Sci 62:233–241
Ouvrier RA, McLeod JG, Conchin T (1987) Morphometric studies of sural nerve in childhood. Muscle Nerve 10:47–53
Pereira JA, Lebrun-Julien F, Suter U (2012) Molecular mechanisms regulating myelination in the peripheral nerve. Trends Neurosci 35:123–134
Phillips LH, Park TS (1993) Electrophysiological mapping of the segmental innervation of the saphenous and sural nerves. Muscle Nerve 16:827–831
Piña-Oviedo S, Ortiz-Hidalgo C (2008) The normal and neoplastic perineurium: a review. Adv Anat Pathol 15:147–164
Pollard JD, Baverstock J, McLeod JG (1987) Class II antigen expression and inflammatory cells in the Guillain-Barre syndrome. Ann Neurol 21:337–341
Prineas JW, McLeod JG (1976) Chronic relapsing polyneuritis. J Neurol Sci 27:427–458
Quintes S, Goebbels S, Saher G et al (2010) Neuron-glia signaling and the protection of axon function by Schwann cells. J Peripher Nerv Syst 15:10–16
Reina MA, Lopez A, Villanueva MC et al (2003) La barrera hematonerviosa en los nervios perifericos. Rev Esp Anestesiol Reanim 50:80–86
Richard L, Topilko P, Magy L et al (2012) Endoneurial fibroblast-like cells. J Neuropathol Exp Neurol 71:938–947
Roytta M, Salonen V (1988) Long term endoneurial changes after nerve transection. Acta Neuropathol 76:35–45
Salonen V, Roytta M, Peltonen J (1987) The effects of nerve transection on the endoneurial collagen fibril sheaths. Acta Neuropathol 74:13–21
Schellens RLLA, van Veen BK, Gabreels-Festen AAWN et al (1993) A statistical approach to fiber diameter distribution in human sural nerve. Muscle Nerve 16:1342–1350
Scherer SS, Wrabetz L (2008) Molecular mechanisms of inherited demyelinating neuropathies. Glia 56:1578–1589
Schlaepfer WW, Myers FK (1973) Relationship of internode elongation and growth in the rat sural nerve. J Comp Neurol 147:255–266
Schroder JM, Bohl J, Brodda K (1978) Changes of the ratio between myelin thickness and axon diameter in the human developing sural nerve. Acta Neuropathol 43:169–178
Sharma AK, Thomas PK (1975) Quantitative studies on age changes in unmyelinated nerve fibers in the vagus nerve in man. In: Kunze K, Desmedt JE (eds) Studies on neuromuscular diseases. S Karger, Basel, pp 211–219
Shellswell GB, Restall DJ, Duance VC, Bailey AJ (1979) Identification and differential distribution of collagen types in the central and peripheral nervous system. FEBS Lett 106:305–308
Sjo O, Buchthal F, Henriksen O et al (1976) The absence of fibres in the sural nerve mediating vasoconstriction. Acta Physiol Scand 98:379–380
Spencer PS, Weinberg GH, Raine CS, Prineas JW (1975) The perineurial window. A new model of focal demyelination and remyelination. Brain Res 96:323–329
Sunderland S (1978) Nerves and nerve injuries, 2nd edn. Churchill Livingstone, Edinburgh, pp 46–57
Suzuki M (2013) Peripheral neuropathy in the elderly. In: Said G, Krarup C (eds) Peripheral nerve disorders, vol 115, Handbook of clinical neurology (3rd series). Elsevier, Amsterdam, pp 803–813
Takahashi J (1966) A clinicopathologic study of the peripheral nervous system of the aged: sciatic nerve and autonomic nervous system. Geriatrics 21:123–133
Thomas PK (1963) The connective tissue of peripheral nerve: an electron microscope study. J Anat 97:35–44
Thomas PK, Bhagat S (1978) The effect of extraction of the intrafascicular contents of peripheral nerve trunks on perineurial structure. Acta Neuropathol 43:135–141
Thomas PK, Berthold CH, Ochoa J (1993) Microscopic anatomy of the peripheral nervous system. In: Dyck PJ, Thomas PK et al (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, pp 28–73
Tohgi H, Tsukagoshi H, Toyokura Y (1977) Quantitative changes with aging in normal sural nerves. Acta Neuropathol 38:213–220
Waggener JP, Beggs J (1967) The membranous coverings of neural tissues: an electron microscope study. J Neuropathol Exp Neurol 26:412–426
Webster D dF (1993) Development of peripheral nerve fibers. In: Dyck PJ, Thomas PK et al (eds) Peripheral neuropathy, 3rd edn. WB Saunders, Philadelphia, pp 243–266
Weis J, Alexianu ME, Heide G, Schroder JM (1993) Renaut bodies contain elastic fiber components. J Neuropathol Exp Neurol 52:444–451
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Bilbao, J.M., Schmidt, R.E. (2015). Normal Anatomy of the Peripheral (Sural) Nerve. In: Biopsy Diagnosis of Peripheral Neuropathy. Springer, Cham. https://doi.org/10.1007/978-3-319-07311-8_2
Download citation
DOI: https://doi.org/10.1007/978-3-319-07311-8_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-07310-1
Online ISBN: 978-3-319-07311-8
eBook Packages: MedicineMedicine (R0)