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PubMed1988

[Preserving the accessory nerve in neck dissection].

A total of 104 patients who had undergone neck dissection were examined with respect to disturbance of shoulder function on the operated side. The accessory nerve had been severed in half the patients and preserved in the other half. A dynamo-meter was used to measure the force a patient standing upright could exert in pulling upward with his arm outstretched. The relative loss of strength after neck dissection was determined by relating the difference between the two sides to the strength of the healthy shoulder. On average, the loss of strength in the operated shoulder was significantly less after preservation of the accessory nerve than after its severance. An additional influence due to tumour stage or postoperative irradiation was not found. The functional loss determined by the difference quotient correlated well with the patients' subjective account of their functional impairment. Preservation of the eleventh cranial nerve is discussed with respect to the question of increased risk of lymph node recurrence.

Accessory Nerve↗
PubMed1994

[Traumatic lesions of the spinal accessory nerve. II: clinical study and results of a series of 25 cases].

INTRODUCTION: Trapezius muscle paralysis after accessory nerve injury was mostly seen after a so called minor surgery of the neck: 17 lesions among 25 appeared after the excision of a cervical cyst or a small benign tumor. This notion should be remembered because the prevention of this paralysis is easy. MATERIAL AND METHODS: In the established lesion, the repair is to be done as soon as possible. The authors report a retrospective study of 25 cases of traumatic accessory nerve injury, followed from 1983 and 1992. A nerve repair was done in 15 cases. It consisted in an average 5 centimeters graft in 10 cases, an intramuscular neurotization in 4 cases, a direct suture in 1 case, and a neurolysis in 6 cases. A palliative treatment was suggested in 4 cases. RESULTS: The mean follow up was 15 months (range 6 to 57 months) and 22 operated cases had more than a 1 year follow up. We observed 10 good results for 10 grafts, 1 good result after 1 direct suture; the 4 neurotisations has 3 good results and 1 average result; the 6 neurolysis had 1 very good, 4 good and 1 poor results and in one case there was no possibility of repair. DISCUSSION AND CONCLUSION: The authors underline the good results after nerve repair following a lesion near from the paralysed muscle and also the need for prevention.

Adolescent↗
PubMed2002

Anomalous relationship of the spinal accessory nerve to the internal jugular vein.

A patient with an early cancer of the tongue and undergoing a staging neck dissection was noted to have an anomalous relationship of the internal jugular vein and spinal accessory nerve. At the upper end of the dissection (level II, Memorial Sloan-Kettering classification), the internal jugular vein was observed to divide above and reconstitute below the spinal accessory nerve. Although apparently not previously described in the literature, this finding may be encountered by other surgeons who operate in this area, and it is important that these anatomical variations are borne in mind to prevent inadvertent injury.

Accessory Nerve↗
PubMed1984

Neurinoma of the spinal accessory nerve. A case report.

A case of neurinoma of the spinal accessory nerve without evidence of von Recklinghausen's disease is described. The difference in the clinical symptoms and radiological findings between this tumour and a jugular foramen neurinoma is especially emphasized. Other cases in the world literature are also reviewed and the peculiarities of the tumour are discussed.

Accessory Nerve↗
PubMed1980

[Course of the external branch of the accessory nerve and its relations with the first portion of the internal jugular vein (author's transl)].

This report is based upon microdissections of 32 right and left hemi-heads. It was observed in 26 pieces of both sides that the external branch of the accessory nerve turns round the medial surface and next to posterior surface of the first portion of the internal jugular vein. In 6 pieces obtained from both sides it was observed that the nerve turns round the anterior surface and next to lateral surface of the internal jugular vein. In the superior portion of the neck, the accessory nerve is also in the interior of the carotid sheath and is involved by an subdivision of this sheath. At this level, the nerve perfurates the carotid sheath and runs down obliquely, to outside and to behind reaching the deep surface of the sternocleidomastoid and the trapezius muscles.

Accessory Nerve↗
PubMed1994

The development of the spinal accessory nerve in human embryos during 5th week (stages 14 and 15).

The spinal part of the accessory nerve was investigated in serially sectioned human embryos at developmental stages 14 and 15. It has been recognized that the spinal accessory nucleus extends through the upper 4 or 6 cervical segments of the spinal cord. The nucleus is formed by group of cells lying dorsolaterally to the primordium of the ventral horn. There is no continuation of the cells forming the spinal nucleus of the XIth nerve with primordium of the nucleus ambiguus. Extramedullary roots of the spinal accessory nucleus form a long trunk ascending into skull and uniting with vagus nerve. In one embryo at stage 15 the spinal accessory nerve separates at the level of the lower ganglion of the vagus.

Accessory Nerve↗
PubMed1986

The accessory nerve nucleus in the baboon.

In the savanna baboon, Papio cynocephalus, the accessory nerve nucleus was identified by using a mixture of 20% free horseradish peroxidase (HRP) and 2.5% HRP conjugated to wheat germ agglutinin (WGA) in a 5% aqueous detergent solution (Nonidet P-40). Following surgical exposure of the appropriate nerve branch to the sternocleidomastoid or trapezius muscle, the nerve was transected, placed in an Argyle tubing collar, and bathed in 5-10 microliter of the tracer. After a 48-hour survival time and vascular perfusion-fixation, 40-micron sections of the lower medulla oblongata and the cervical spinal cord were treated according to the tetramethyl benzidine (TMB)-HRP method of Mesulam (J. Histochem. Cytochem. 26: 106-117, 1978). The accessory nucleus extends as a distinct column of neurons from lower medullary levels into the rostral part of C5. One to ten labeled cells were present in each section, and all labeled neurons were located on the side of the bathed nerve. The rostral portion of the accessory nucleus occupies a central position, its intermediate portion occupies a lateral position, and its caudal portion occupies a central position within the ventral horn. All labeled neurons were confined to Rexed's lamina IX, ranged from 15 to 75 micron in diameter, and were either distinctly round (oval) or stellate in shape. Neurons within the baboon accessory nucleus supplying the sternocleidomastoid muscle were located from lower medullary to upper C2 spinal cord levels, while those supplying the trapezius muscle extended from C2 to C5.

Accessory Nerve↗
PubMed2006

Accessory nerve injury.

This article discusses a Supreme Court judgment involving an injury to the spinal accessory nerve which occurred during the excision of a lymph node mass in the posterior triangle of the neck.1 In this case, the medical practitioner was found to have been negligent for failing to diagnose the nerve injury in the postoperative period, and not for the actual injury to the nerve during the procedure.

Abscess↗
PubMedDate not supplied

A technique for preservation of spinal accessory nerve function in radical neck dissection.

A new technique is described that preserves trapezius muscle function in radical neck surgery while cutting that part of the spinal accessory nerve which courses through the sternocleidomastoid muscle. The technique takes advantage of the little-know fact that, in humans, the trapezius muscle has dual innervation. The C2-3-4 motor root is joined to the distal portion of the spinal accessory nerve to give motor function to the trapezius muscle. This procedure will save shoulder mobility in the majority of patients who undergo radical neck dissection. The technique is accomplished rapidly with the use of the gastrointestinal stapler in the scalene fat pad.

Head and Neck Neoplasms↗
PubMed1977

Accessory nerve palsy.

After apparently uncomplicated excision of benign lesions in the posterior cervical triangle, two patients had shoulder pain. In one, neck pain and trapezius weakness were not prominent until one month after surgery. Inability to elevate the arm above the horizontal without externally rotating it, and prominent scapular displacement on arm abduction, but not on forward pushing movements, highlighted the trapezius dysfunction and differentiated it from serratus anterior weakness. Spinal accessory nerve lesions should be considered when minor surgical procedures, lymphadenitis, minor trauma, or tumours involved the posterior triangle of the neck.

Accessory Nerve↗
PubMed1981

Treatment of neurogenic torticollis by microvascular lysis of the accessory nerve roots - indication, technique, and first results.

For treatment of spasmodic torticollis (s.T.) microsurgical decompression of the intraspinal-intracranial portion of the accessory nerve (a.N.) has been performed in 11 patients with proved neurogenic lesions of the accessory nerve-dependent muscles. Neurogenic lesions were discovered by meticulous electromyographic (EMG) examination in 26 out of 32 patients with s.T. Based on the EMG findings and a.N. roots were exposed, mostly bilaterally. During operation we found in each case tight adhesions to adjacent structures, in particular the vertebral artery (v.A.), the posterior inferior cerebellar artery (PICA), and spinal arteries. Moreover, various nerve anastomoses were found between the upper dorsal cervical roots and the spinal a.N. roots. After neurovascular lysis and dissection of anastomoses, to C 1 in particular, the a.N. was protected with teflon-foam (Prosthex). Immediately after surgery torticollis had improved in all but one case. Further improvement was achieved by exercises. These first favourable results, and the fact that nerve decompression is less destructive that other surgical procedures in treatment of s.T., make us feel justified in recommending this procedure further to patients suffering from s.T. with proved neurogenic lesions.

Accessory Nerve↗
PubMed1996

Bilateral myoclonus of the trapezius muscles after distal lesion of an accessory nerve.

Observations of rhythmic or semirhythmic myoclonus due to a peripheral nerve lesion are exceptional. We report on a patient with thorax trauma with multiple bilateral hematomas of the paravertebral musculature. Eight years later he developed rhythmic myoclonus of both trapezius muscles and thoracic pain. Infiltration of a paramedially located scar at the level of D5-6 with a local anesthetic agent led to an intermittent relief of the myoclonus as did anesthetic blockade of the left accessory nerve. Surgical excision of the scar, which contained multiple dystrophic axons on histological examination, cured the patient's symptoms as illustrated in a videotape. This indicates that peripheral afferents contributed to the myoclonus. Ephaptic transmission, ectopic excitation, or misdirected neuronal sprouting secondary to the trauma are possible peripheral mechanisms responsible for the movement disorder. Successful blockade of the left accessory nerve with bilateral relief of the symptoms suggests a secondary, more centrally located mechanism, e.g., in the brain stem, probably driven by an altered afferent input. It is concluded that rhythmic or semirhythmic and focal myoclonus need a careful workup to look for a peripheral cause because such a condition would be accessible for surgical treatment.

Accessory Nerve↗
PubMed1983

Iatrogenic spinal accessory nerve palsy.

Four patients were referred to the Royal National Orthopaedic Hospital with iatrogenic accessory nerve palsy because their symptoms were severe enough to warrant surgical treatment. The definitive diagnosis was made several months after the initial procedure, when wasting of the trapezius and shoulder dysfunction became apparent. The reasons for this delay are discussed along with prophylaxis and surgical technique of treatment. Less significant degrees of paralysis manifest themselves on return to activity in which the hands are required to be above shoulder level. Electromyograms in these cases will confirm the diagnosis (1).

Accessory Nerve Injuries↗