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PubMedDate not supplied

Occurrence, duration and prognosis of unexpected accessory nerve paresis in radical neck dissection.

Injuries to the spinal accessory nerve in connection with radical neck dissection occur frequently, despite the preservation of the nerve. Although the surgeon was unaware of any serious lesion of the accessory nerve, a trapezius paresis of varying degree was observed in about 60% of the patients during convalescence. The shoulder function improved in most patients, but major paresis with loss of essential rotary and supportive functions of the trapezius muscle persisted in 17% of the patients operated on. No further improvement was seen 18 months after the surgical trauma.

Accessory Nerve Injuries↗

PubMed2000

[Neuropathies of the spinal accessory nerve secondary to cervical surgery: clinical and electrophysiological study of 7 cases].

After innervating the sternocleidomastoid muscle, the spinal accessory nerve emerges and down crosses the posterior cervical triangle to innervate the trapezius. At the posterior triangle, the nerve is closely related to local lymph nodes and may be injured by their enlargement or surgical removal. Injury to this nerve is uncommom. Most cases are iatrogenically due to surgical procedures in the posterior cervical triangle, often following lymph nodes biopsies or benign turmors approaches. We present seven cases of post-surgical related spinal accessory nerve injury and discuss its clinical and electrophysiologycal profiles. The major motor signs were shoulder drop and paresis to raise arm. Pain and sensory complaints were almost universal and most probably due to concomitant injury of cervical plexus cutaneous branches, which are in direct relation to the spinal accessory nerve in the posterior cervical triangle. Lesion type is usually axonotmesis, but varied degrees of compression by cicatricial spurs are observed in some patients. Surgical approach and nerve repair must be considered for pacients with delayed recovery.

Accessory Nerve Diseases↗

PubMed1990

Accessory nerve conduction in neck dissection subjects.

Evaluation of the accessory nerve and trapezius muscle was performed on eight subjects with neck dissection secondary to oropharyngeal/laryngeal cancer. The latencies and amplitudes of the upper, middle, and lower trapezius muscle in neck dissection subjects were compared to those in healthy subjects similar in age. Subjects after neck dissection showed abnormalities of evoked responses and abnormal spontaneous discharges in electromyographic studies of the upper trapezius. Future serial studies that seek prognostic indicators of shoulder dysfunction common to neck dissection patients are warranted.

Accessory Nerve↗

PubMed1993

[Treatment of accessory nerve injury].

From 1975 through 1988, 11 cases with accessory nerve injury were admitted to our hospital. The etiology in 9 of these cases was inadvertent surgical injury during operation. In the other 2 cases it was injured in accidents. The typical clinical manifestations of paralysis of the trapezius muscle and disorder of the shoulder movement were all seen in our cases. The diagnostic features, indications for operation, surgical technics and criteria for efficacy assessment were discussed. The necessity of early operation was stressed, and either neurorrhaphy or neurolysis should be done.

Accessory Nerve↗

PubMed2005

Superficial landmarks for the spinal accessory nerve within the posterior cervical triangle.

OBJECT: The spinal accessory nerve (SAN) within the posterior cervical triangle (PCT) is the most commonly iatrogenically injured nerve in the body. Nevertheless, there is a paucity of published information regarding superficial landmarks for the SAN in this region. Additional identifiable landmarks of this nerve may assist the surgeon in identifying it for repair, use of it in peripheral nerve neurotization, or avoiding it as in proximal brachial plexus repair. The present study was undertaken to provide reliable superficial landmarks for the identification of the SAN within the PCT. METHODS: The PCT was dissected in 30 cadaveric sides. Measurements were made between the SAN and surrounding landmarks. The mean distances between the entry site of the SAN into the trapezius and a midpoint of the clavicle, mastoid process, acromion process, and lateral aspect of the sternocleidomastoid (SCM) muscle were 6, 7, 5.5, and 3.5 cm, respectively. The mean distances between the angle of the mandible and the mastoid process and the exit point of the SAN from the posterior border of the SCM muscle were 6 and 5 cm, respectively. The mean width and length of the SAN were 3 and 3.5 cm, respectively. CONCLUSIONS: It is the authors' hope that these data will aid those who may need to locate or avoid the SAN while undertaking surgery in the PCT and thus decrease morbidity that may follow manipulation of this region.

Accessory Nerve↗

PubMed1985

Considering the spinal accessory nerve in head and neck surgery.

Loss of trapezius muscle function represents the single most important source of long-term morbidity from a radical neck dissection. Its preservation has been one of the central features of the conservative or modified neck dissection. We recently undertook an evaluation of 100 consecutive patients who had undergone composite resection for head and neck cancer and examined them with particular emphasis on the function of the trapezius muscle. The mean interval from the time of radical neck dissection to the time of this evaluation was 6.2 years. The operations included radical neck dissection with sacrifice of the spinal accessory nerve, radical neck dissection with preservation of the spinal accessory nerve, and radical neck dissection with interpositioned cable graft reconstruction. The survey showed that 67 percent of the patients who underwent radical neck dissection with sacrifice of the spinal accessory nerve, although they showed profound atrophy of the trapezius muscle, had few symptoms related to this deficit. Similarly, 47 percent of patients who underwent radical neck dissection with preservation of the spinal accessory nerve showed some signs of muscle atrophy, and 20 percent showed little or no function of the muscle. Interpositioned nerve grafts appeared to function well in 66 percent of the patients. The survey showed that a surprising number of patients treated with a standard radical neck dissection and sacrifice of the spinal accessory nerve had few postoperative symptoms related to the loss of trapezius muscle function. Also unexpected was the number of patients with signs of muscle dysfunction despite nerve preservation.

Accessory Nerve↗

PubMed1994

Accessory nerve neurotization in infants with brachial plexus birth palsy.

We report the surgical results of 13 accessory nerve neurotizations in branchial plexus birth palsy. The mean age at operation was 5.9 months. The accessory nerve was transferred to three C5 roots, to three C6 roots, to four posterior division of the middle trunks, to one musculocutaneous nerve, and to two suprascapular nerves. Sixty-seven percent of the cases acquired M4 or more in the deltoid muscle, 88% in the infraspinatus muscle, and 100% in the biceps brachii muscle. Twenty-five percent of the cases acquired M4 or more in the triceps brachii muscle and the wrist extensor muscles. These results were much better than formerly reported for adult cases by other authors. No functional compromise of the trapezius muscle was noted. The accessory nerve neutrotization can be used safely and effectively in neurosurgical reconstruction of the brachial plexus palsy in infants.

Accessory Nerve↗

PubMed1999

The excitation site of the accessory nerve to the magnetic stimulation--the relationship between the orientation of the magnetic field and the excitation site.

OBJECTIVE: The relationship between the accessory nerve excitation site and the magnetic field direction was investigated to prove whether the cranial nerve excitation site to the transcranial magnetic stimulation is constant or not. METHODS: Compound muscle action potentials (CMAPs) elicited by the transcranial magnetic stimulation were recorded from the trapezius muscles of 7 adult cats. The waveforms of CMAPs were detected before craniectomy, after craniectomy, and after cutting the accessory nerve at the C1, at the jugular tubercle, and at the jugular foramen. The optimal orientation was determined by rotating the coil clockwise in increments of 22.5 degrees from the rostral direction. RESULTS: The accessory nerve was stimulated by the magnetic stimulation at the C1, at the jugular tubercle or at the jubular foramen, and these excitation sites varied with coil orientation. The average angles of the optimal orientation of the magnetic coil were 77.1 degrees for C1, 122.1-263.6 degrees for the jugular tubercle, and 308.6-32.1 degrees for the jugular foramen. CONCLUSIONS: The accessory nerve excitation site varied with the orientation of the magnetic coil. This study suggested the possibility of a variety of the cranial nerve excitation sites to the transcranial magnetic stimulation.

Accessory Nerve↗

PubMed1999

Sensory pathways in the spinal accessory nerve.

We obtained samples of spinal accessory nerve from patients undergoing radical surgery for tumours or nerve grafting in the neck. These were analysed by light and electron microscopy for the type of fibre. All contained fibres consistent with non-proprioceptive sensory function including pain.

Accessory Nerve↗

PubMed2006

Accessory nerve function in lateral selective neck dissection with undissected level IIb.

BACKGROUND: To investigate the accessory nerve function in lateral selective neck dissections (LSND) performed in laryngeal squamous cell carcinoma patients without dissection of level IIB. METHODS: Fifteen LSND were performed in 11 N0 laryngeal carcinoma patients with preservation of level IIB. Distal latencies, compound muscle action potentials (CMAP), and electromyography findings were investigated before surgery, during the 3rd postoperative week, and 3 months thereafter to compare the effects of the procedure on the accessory nerve. RESULTS: Distal latencies and CMAP values were significantly lower in the early and late postoperative periods when compared with preoperative values. In 8 patients, there was no motor unit potential (MUP) in the early postoperative period. However, in the late postoperative period, there was no MUP loss. CONCLUSIONS: Only temporary functional deterioration of the accessory nerve was seen in patients in whom LSND was performed with undissected level IIB.

Accessory Nerve↗

PubMed1991

Central-peripheral transitional zone of the spinal accessory nerve in the rat.

The spinal accessory nerve rootlets emerge from the lateral aspect of the upper five segments of the cervical spinal cord underlying the nerve trunk. They cross the lateral funiculus of the cord with a slight rostral inclination. Here some pursue a relatively straight course while others have a dorsal convexity. The transitional zones may be classified into three distinct types, related to their orientation as they traverse the glia limitans to emerge as free rootlets. The fibres in Type 1 rootlets bend sharply rostrally on reaching the glia limitans. Type 2 rootlets turn ventrally to run in the glia limitans in the transverse plane of the cord before emerging. Type 3 rootlets are found only at C1. Their fibres initially turn caudally in the glia limitans and then loop rostrally. The morphology of the central-peripheral transitional zones of the spinal accessory rootlets closely resembles that of cervical ventral rootlets, and is therefore correlated with the motor function of these rootlets rather than with their intermediate location between the ventral and dorsal cervical rootlets.

Accessory Nerve↗

PubMed1988

[Accessory nerve paralysis due to compression of the fenestrated vertebral artery].

Neurological involvement due to fenestrated vertebral artery has not yet been reported, although fenestration formation by vertebral arteries is not rare. Reported here is one such rare case. In this case accessory nerve paralysis developed due to fenestrated vertebral artery. A 51-year-old woman was admitted to our department with tilting of the head to the right side as her chief complaint. This had gradually developed over a period of approximately one year. Neurological examination on admission showed the presence of marked atrophy of the left sternocleidomastoid muscle with hyperactive deep tendon reflexes in her four limbs. Metrizamide CT scan showed compression of the upper cervical cord at the left side, and an abnormal small high density area was found at the same site on contrast enhanced CT scan. Left vertebral angiogram showed fenestration formation of the left vertebral artery at C1 level. Surgical decompression for the left accessory nerve and high spinal cord was planned because of the occurrence of symptoms due to compression of the fenestrated vertebral artery. C1 and C2 laminectomy was performed and the dura was opened in prone position. The fenestrated vertebral artery of the intraspinal portion was confirmed to be compressing the spinal root of the accessory nerve and high cervical cord. Initially, trapping of the fenestrated vertebral artery was attempted in the hope of sufficiently relieving compression on the accessory nerve and high cervical cord. This attempt resulted in failure, since auditory evoked response became definitely abnormal within two minutes following interruption of this abnormal artery. Because of this, insertion of Ivaron sponges between the abnormal artery and the accessory nerve was all that could be done.(ABSTRACT TRUNCATED AT 250 WORDS)

Accessory Nerve↗

PubMed1996

Reconstruction of the spinal accessory nerve with an anastomosis to the dorsal C3 branch: technical note.

Most lesions of the spinal accessory nerve are of traumatic origin. If the proximal part is sectioned next to its exit from the cranial base, the reconstruction might be difficult. In such a case, one option is intracranial identification of the spinal accessory nerve and transdural interposition of a graft to its distal stump. Cerebrospinal fluid leaks or infections, caudal nerve palsies, or even spinal neurological deficits are possible complications. From more than 70 patients who underwent selective peripheral denervations for the treatment of spasmodic torticollis in our department, we have learned that the dorsal C1-C6 branches can be sectioned without any functional impairment. The dorsal C2 and C3 branches have diameters comparable to that of the spinal accessory nerve. They contain between 600 and 700 myelinated fibers per square millimeter. Therefore, they seem to be ideal proximal donors for the reconstruction of a severed motor nerve. They may be used in patients with peripheral nerve injuries in the craniocervical region, if other possibilities are not suitable.

Accessory Nerve↗

PubMed1996

Asystole from tetanic stimulation of the accessory nerve.

An asystolic cardiac arrest is reported which occurred at the same time as supramaximal tetanic stimulation over the accessory nerve in order to evoke contractions in the trapezius and sternocleidomastoid muscles. The cause may have been the inadvertent stimulation of one or more of the cranial nerves of the carotid sheath at the base of the skull: the cranial root of the accessory nerve, the vagus, the sino-carotid branch of the glossopharyngeal nerve or the hypoglossal nerve. The most likely culprit, if not the vagus itself, was the cranial root of the accessory nerve which both functionally and anatomically should be seen as an integral part of the vagus. It is suggested that stimulation of any nerve in the carotid sheath should be approached with caution and that a tetanic stimulus to this area might best be avoided.

Accessory Nerve↗

PubMed1991

Accessory nerve palsy: a review of 23 cases.

In a series of 23 patients, the commonest cause of accessory nerve palsy was surgical trauma at the time of lymph node biopsy. The less common causes were penetrating or blunt trauma and a few were of spontaneous onset. There was involvement of adjacent motor sensory nerves in about half of the patients. The prognosis was better following blunt trauma, stretch injuries and after a spontaneous onset. The anatomical relationships of the accessory nerve and aspects of the clinical picture and management are discussed.

Accessory Nerve↗

PubMed1994

[The spinal accessory nerve (n. accessorius) I: anatomical study].

INTRODUCTION: In order to increase knowledge of the spinal accessory nerve concerning its situation, trajectory and terminal branches and also the connections with the cervical plexus, the authors report an anatomical study based on 11 dissections of the trapezius muscle mode of innervation and the connections between the accessory nerve, the sternocleidomastoid and trapezius muscles. DISCUSSION: The accessory nerve is a muscular nerve and supplies the main innervation to the trapezius muscle especially for the superior and middle sections. There is a clear participation of the cervical plexus either through the trapezius muscle by nerve anastomosis behind the trapezius or directly especially in the distal portion. CONCLUSION: This anatomical study allows a better understanding of the clinical aspects and the indications of nerve repairs.

Aged↗

PubMed2005

Upper neck spinal accessory nerve identification during neck dissection.

Iatrogenic injury to the spinal accessory nerve (SAN) during neck dissection may result in significant and avoidable morbidity in the form of 'shoulder syndrome'. The authors describe a simple method, based on the anatomy of the sternocleidomastoid muscle (SCM), which allows consistent and rapid identification of the SAN in the upper neck during dissection, thereby facilitating its preservation.

Accessory Nerve↗

PubMed1983

Functional evaluation of the spinal accessory nerve after neck dissection.

The pain and dysfunction associated with a loss of innervation by the spinal accessory nerve has motivated surgeons to modify the classic radical neck dissection. A prospective study of 109 patients who underwent either a radical neck dissection or a modification of it with preservation of the spinal accessory nerve revealed that those patients in whom the nerve, muscle, and vein were preserved had less dysfunction (30 percent) than those with nerve preservation only (50 percent) or classic radical neck dissection (60 percent). In addition, even when the functional disability was the same, there was less associated pain with nerve-sparing procedures. Furthermore, a large group of patients (40 percent) who underwent classic radical neck dissection had minimal disability. Given these results, a prospective study of recurrence data in these patients is indicated.

Accessory Nerve↗