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PubMedDate not supplied

Cervical metastases following radical neck dissection that preserved the spinal accessory nerve.

In contrast to the original neck dissection technique, the spinal accessory nerve is routinely sacrificed in the so-called classical neck dissection. The benefit of this routine has never been documented; on the contrary, facts have accumulated that indicate that the nerve should be preserved. The results in this article serve to emphasize this opinion. Of 80 patients who underwent radical neck dissection that preserved the spinal accessory nerve, the potential for cure was not jeopardized in a single case.

Accessory Nerve↗
PubMed1991

Spinal accessory nerve palsy: an unusual complication of coronary artery bypass.

The neurologic complications of coronary artery bypass surgery have been well documented, with a reported incidence of 61% in one large study. Most injuries to the peripheral nervous system involve the brachial plexus. We report the first case of a spinal accessory nerve lesion after coronary bypass surgery. The patient presented with progressive right shoulder weakness. Electrodiagnostic studies revealed a partial lesion of the right spinal accessory nerve. Physical therapy, including strengthening, range of motion, and electric stimulation to the right shoulder, was prescribed to assist recovery of strength and function. Repeat electrodiagnostic studies confirmed nerve regeneration. Prompt recognition of spinal accessory nerve damage after coronary bypass surgery is essential. Early rehabilitation will improve the chances of a better functional outcome.

Accessory Nerve↗
PubMed2000

Accessory nerve function after modified radical and lateral neck dissections.

OBJECTIVES: Evaluate preoperative and postoperative electrophysiological changes related to the accessory nerve with reference to dissection technique, modified radical neck dissection, and lateral neck dissection. STUDY DESIGN: Prospective electrophysiological analysis of accessory nerve function in a total of 20 laryngeal carcinoma patients after neck dissection, 12 being lateral neck dissection (4 bilateral) and 8 being modified radical neck dissection. METHODS: Distal latencies, compound muscle action potentials, and electromyography findings were investigated before surgery and, in early and late postoperative periods in 20 laryngeal carcinoma patients. Results were evaluated by Student t test and chi2 test for intragroup and intergroup differences. RESULTS: In the lateral neck dissection group, postoperative distal latencies were longer, without statistical significance, whereas in the modified radical neck dissection group postoperative latencies were statistically longer. Postoperative compound muscle action potentials were significantly lower in both groups. Electromyographic work-up showed deterioration in early postoperative periods and improvement in late postoperative periods. When intergroup differences were compared, both postoperative compound muscle action potential and electromyographic findings were worse in the lateral neck dissection group. CONCLUSIONS: The accessory nerve function after modified radical neck dissection is better than function after lateral neck dissection because of increased stress applied to the nerve during retraction of the sternocleidomastoid muscle for achievement of a better exposed surgical field in lateral neck dissection.

Accessory Nerve↗
PubMed1975

An experimental study concerning the accessory nerve in the chicken and turkey.

The retrograde degeneration consecutive to accessory nerve transection proved that the real origin of this nerve in the chicken and turkey is represented exclusively by the ipsilateral dorso-central motor column described by BECCARI (1943). This nucleus, with a moniliform aspect, extends into the first two cervical neuromeres and enters the bulb, where it is continuous with the alpha subdivision of the hypoglossal nucleus. The accessory nerve of the two species of birds is homologous with the external ramus of the same nerve in mammals. An internal ramus is absent in birds.

Accessory Nerve↗
PubMed1992

Afferent projections in the spinal accessory nerve to the facial motoneurons of the cat.

Stimulation of the accessory nerve evoked polysynaptic excitatory postsynaptic potentials (EPSPs) in the facial nucleus (FN) neurons of anesthetized cats. From the experiments with severance of C1-C3 dorsal roots, it is suggested that accessory afferents enter the brainstem through the accessory nerve. It was also found that stimulation of the solitary tract nucleus produced exclusively monosynaptic EPSPs in the FN neurons and the afferent volleys are most likely to be relayed at the solitary tract nucleus.

Accessory Nerve↗
PubMed1995

Magnetic stimulation of the spinal accessory nerve: normative data and clinical utility in an isolated stretch-induced palsy.

We report the clinical and electrophysiological findings of isolated stretch-induced accessory nerve palsy obtained by using conventional technique compared to magnetic stimulation at the base of the skull. The same methods of magnetic stimulation were applied in 10 healthy volunteers, to determine normal limits of amplitude and latency of the motor responses. The clinical features of the isolated spinal accessory nerve palsy are weakness of the sternocleidomastoid muscle and of the three portions of trapezius muscle. Most commonly reported etiologies include surgical manipulation and excision in the posterior triangle of the neck. Less frequently the cause is represented by radiation procedures, shoulder traction, penetrating, blunt or stretch injuries; this last etiology is extremely rare. The use of conventional electrophysiological methods to evaluate injuries of the nerves leaving the base of the skull is limited by the difficulty in obtaining an adequate electrical surface stimulation necessitating the use of needle electrodes. Moreover, conventional electrical stimulation often causes significant discomfort to the patient. The magnetic coli stimulation at the base of the skull is a new alternative painless technique that permits to elicit motor responses, by stimulating deeply situated nerves and, in particular, the accessory nerve, resulting as a useful electrodiagnostic tool.

Accessory Nerve↗
PubMed1994

Isolated accessory nerve palsy of unusual cause.

We report the case of a 23 year old male patient who presented for an isolated left accessory nerve palsy which had appeared one year before. Neuroradiological investigations showed that the causative pathology was a giant saccular aneurysm of the intracranial left vertebral artery. Three months after diagnosis, signs of bulbar palsy rapidly developed. An emergency intra-arterial embolization was then attempted, which led to complete recovery except for the accessory nerve palsy which remained unchanged. We conclude that, in cases of apparently isolated accessory nerve palsy, neuroradiological investigations should include the posterior fossa.

Accessory Nerve↗
PubMed2001

Relations of the accessory nerve with the internal jugular vein: surgical implications in cervical lymph node clearances.

The position of the lateral branch of the accessory nerve in relation to the internal jugular vein is given variously by different authors. In surgery of the neck, and especially in conservative cervical lymph node clearances, the lateral branch of the accessory nerve is protected when it is situated lateral to the vein. However, when the nerve is medial to the vein there is a risk of damage to the internal jugular vein. A prospective preoperative study of 123 cervical lymph node clearances, as well as a dissection study of 5 fresh subjects, was carried out to determine the position of the lateral branch of the accessory nerve in relation to the internal jugular vein. The surgical study showed that the lateral branch of the nerve was anterior and lateral to the vein in 122 of the 123 clearances, while the cadaveric study found the nerve always anterior and lateral to the vein. Thus the risk of injuring the internal jugular vein during cervical lymph node clearances is very small. The differences observed by authors may be explained by collapse of the internal jugular vein observed during cadaveric dissections.

Accessory Nerve↗
PubMedDate not supplied

[The results of microvascular decompression of the accessory nerve in patients with spastic torticollis].

The results of microvascular decompression of accessory nerve in patients with spastic torticollis are reviewed. 40 patients with spastic torticollis were treated. Unilateral microvascular decompression of the XIth cranial nerve were used in 11 cases, lateral in 23 cases. 5 patient had complete recovery, positive results were achieved in 12 patients. Best results were observed after bilateral decompression including retrocollis patients. Surgical treatment of laterocollis patients was less successful. Unilateral microvascular decompression of accessory nerve proved to be effective in homolateral type of torticollis.

Accessory Nerve↗
PubMed1989

Neurons of origin of the internal ramus of the rabbit accessory nerve: localization in the dorsal nucleus of the vagus nerve and the nucleus retroambigualis.

The neurons of origin of the internal ramus of the rabbit accessory nerve were identified in the dorsal nucleus of the vagus nerve, using bilateral injections of horseradish peroxidase into the inferior vagal ganglion, soft palate, and pharynx, which were preceded by different combinations of the unilateral intracranial severings of the rootlets of the vagus and glossopharyngeal nerves, those of the cranial root of the accessory nerve, and the trunk of its spinal root. The neurons of origin occupied the caudal four-fifths of the dorsal vagal nucleus extending from about 1.0 mm rostral to the obex as far caudally as the second cervical spinal segment, with their number being about half the total number of neurons of the nucleus. Although considerably fewer, they were also located in the nucleus retroambigualis of the caudal half of the first cervical spinal segment and the second segment. Axons of most internal ramus neurons traversed the rootlets of the cranial accessory root. Axons of the few neurons located more caudally than about 1.0 mm caudal to the obex emerged from the upper cervical spinal cord to run along the trunk of the spinal accessory root before finally joining the internal ramus; caudal to the midlevel of the first cervical segment, the dorsal vagal nucleus and the nucleus retroambigualis contained neurons whose axons followed only that course.

Accessory Nerve↗
PubMed1984

Accessory nerve injury.

A series of 13 patients with an injury of the accessory nerve in the posterior cervical triangle is reported. In 11 patients the nerve was damaged during a lymph node biopsy and in two cases there was a sharp glass injury. Paralysis of the trapezius muscle occurred with resulting deformity and loss of function of the shoulder. Nine patients were operated on. In five cases neurolysis, in two cases neurorrhaphy and in two cases reconstruction with a sural nerve graft were performed 3-17 months after the injury. The result was good or fair in six operative cases. Five of these were neurolyses. In one instance good and in three cases fair recovery was achieved without operation. All but one of the patients were able to return to their former employment. The mean follow-up time was 20 months.

Accessory Nerve↗
PubMed1985

Accessory nerve palsy following carotid endarterectomy. Report of two cases.

Two patients who had an accessory nerve palsy following carotid endarterectomy are presented. Both patients had high carotid bifurcations necessitating unusually high retraction and dissection. The ipsilateral accessory nerve was injured in the anterior cervical triangle in both cases. It is believed that vigorous lateral retraction of the superior aspect of the sternocleidomastoid muscle led to a stretch injury of the nerve. The symptoms completely resolved in both patients within 6 months.

Accessory Nerve↗
PubMed1995

[A case of accessory nerve neurinoma presenting an intracisternal tumor].

A case of neurinoma from the spinal accessory nerve which is located in the cisterna magna is reported. A 54-year-old woman was admitted to the institute in 1990 with complaints of headache, nausea and ataxic gait for several months. Plain CT showed dilation of the lateral ventricles and a mass of lower density in the cisterna magna. The capsule and septa of the mass were enhanced with contrast medium. MRI showed the mass was low intense on T1-weighted images and high intense on T2-weighted images. Gadolinium visualized the mass multicystic. V-P shunt was performed before tumor resection. Through suboccipital craniectomy and C1 laminectomy the tumor was removed. The tumor had a long neck attached to the right spinal accessory nerve and extended to the cisterna magna.

Accessory Nerve↗
PubMed1994

The spinal accessory nerve in human embryos at 6th week (stages 16 and 17).

Investigations were made on serial sections of human embryos at developmental stages 16 and 17 (37-41 days). The spinal nucleus of the accessory nerve presents well delimited cellular group in the dorsplateral part of the ventral horn of the spinal cord. The migration zone is still present. In embryos of stage 16 the spinal accessory nerve joints the fibers originating from the nucleus ambiguous. This takes place at the level of the inferior ganglion of the vagus nerve. In stage 17 the secondary rami of the accessory nerve develop. This is correlated with the differentiation of the sternocleidomastoid and trapezius muscles.

Accessory Nerve↗
PubMed1998

Spinal accessory nerve palsy as a cause of pain after whiplash injury: case report.

Spinal accessory nerve injury is most commonly reported following surgery in and around the posterior cervical triangle. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. We report the case of a collegiate swimmer who developed left-sided neck and shoulder pain secondary to a spinal accessory nerve palsy (SANP) after a "whiplash injury," which we believe to be the first such reported case in the English language literature. We review the clinical manifestations, diagnostic pitfalls, and therapeutic approaches to SANP. A high index of suspicion for SANP following whiplash-type injury will ensure its earlier detection and treatment and improve the chances of a better functional outcome.

Accessory Nerve↗
PubMed1991

Accessory nerve injury after carotid endarterectomy. Case report.

Although cranial nerve injuries associated with carotid endarterectomy are well known, involvement of the accessory nerve is extremely rare. A case of partly reversible accessory nerve injury is described. Hitherto published cases are analyzed and possible pathogenetic mechanisms discussed.

Accessory Nerve Injuries↗
PubMed1991

Accessory nerve neurinoma manifesting with typical jugular foramen syndrome.

A case of neurinoma arising from the accessory nerve is reported. The tumor was small and located entirely within the jugular foramen; the patient sought treatment for a jugular foramen syndrome. The lesion was visualized only on magnetic resonance imaging, and surgery confirmed that it originated from a cranial root of the accessory nerve. There have been no previous reports of a small, accessory neurinoma that is confined entirely to the jugular foramen, appearing with a typical jugular foramen syndrome.

Accessory Nerve↗