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Another (Internal) Epineurium: Beyond the Anatomical Barriers of Nerves
Authors:Miguel A. Reina  André P. Boezaart  R. Shane Tubbs  Yury Zasimovich  Manuel Fernández-Domínguez  Paloma Fernández  Xavier Sala-Blanch
Affiliation:1. Department of Clinical Medical Science, CEU San Pablo University School of Medicine, Madrid, Spain;2. Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida;3. Seattle Science Foundation, Seattle, Washington;4. Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida

Department of Orthopaedic Surgery, University of Florida College of Medicine, Gainesville, Florida;5. Department of Clinical Medical Science, CEU San Pablo University School of Medicine, Madrid, Spain

Department of Maxillofacial Surgery, Madrid-Montepríncipe University Hospital, Madrid, Spain;6. Institute of Applied Molecular Medicine, School of Medicine, University of CEU San Pablo, Madrid, Spain;7. Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain

Abstract:The epineurium has been accepted as the outer anatomical barrier of the peripheral nerves. Our objective was to characterize the microanatomy of the layers surrounding nerves using different tissue-specific staining methods. Two hundred forty-two cross sections of human sciatic and median nerves, and brachial plexuses of eight fresh unembalmed cadavers, were examined. The samples were fixed in formaldehyde solution and stained with hematoxylin–eosin, Masson's trichrome, or epithelial membrane antigen under standard conditions. Because epithelial membrane antigen only stains the perineurium, we demonstrated using hematoxylin–eosin and Masson's trichrome that there were different collagen layers inside and outside the nerves. All fascicles had a collagen layer that surrounded the perineurium and were in close contact with it, with no adipose tissue between them. Unlike the perineurium, this layer, an “internal epineurium,” contained no cells, and it surrounded one or a small group of fascicles. Bundling these fascicles or small groups of fascicles together was the true epineurium, and between the true and internal epineurium, we consistently found an adipose-containing compartment. More proximal to this, the tibial and common peroneal nerves were bundled together by another collagen layer, the circumneurium, which also had a fat-cell-containing compartment deep to it. There were scattered collagen fibers among the adipocytes. Using tissue-specific staining, we were able to demonstrate a collagen layer, the “internal epineurium.” Outside the nerves, we identified several fat-containing concentric compartments. Those compartments were limited by collagen fiber layers that were also similar to the epineurium. Clin. Anat. 33:199–206, 2020. © 2019 Wiley Periodicals, Inc.
Keywords:peripheral nerve  fascicles  epineurium  perineurium  regional anesthesia
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