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PubMed1996

Morphometric investigations of the connections between the posterior C-1 root and the accessory nerve in the human cranial cervical region.

The anastomosis of the spinal section of the accessory nerve and the posterior C-1 root was examined in eight human corpses at the light-microscopical level by image analysis. The numbers of nerve fibers caudal and cranial to the anastomosis were compared. The morphometric data suggest that somatic efferent fibers of the spinal accessory nerve extend to proprioceptors in the sternocleido-mastoideus and trapezius muscles.

Accessory Nerve↗
PubMed1993

Extracranial spinal accessory nerve injury.

Eighty-three consecutive patients with extracranial accessory nerve injury seen over a 12-year period are reviewed. The most common etiology was iatrogenic injury to the nerve at the time of previous surgery. Such operations were usually minor in nature and often related to lymph node or benign tumor removal. Examination usually distinguished winging due to trapezius weakness from that of serratus anterior palsy. Trapezius weakness was seen in all cases. Sternocleidomastoid weakness was unusual. Patients with accessory palsy were evaluated by both clinical and electromyographic studies. Patients who exhibited no clinical or electrical evidence of regeneration were operated on (44 cases). Based on intraoperative nerve action potential studies, 8 lesions in continuity had neurolysis alone. Resection with repair either by end-to-end suture or by grafts was necessary in 31 cases. One case had suture removed from nerve, two had nerve placed into target muscle, and two had more proximal neurotization. Function was usually improved in both operative and nonoperative patients. Related anatomy is discussed.

Accessory Nerve↗
PubMed2001

Respiratory activity in glossopharyngeal, vagus and accessory nerves and pharyngeal constrictors in newborn rat in vitro.

1. Previously, in a brainstem-spinal cord-rib preparation from neonatal rats we demonstrated that a decrement in extracellular pH (from about 7.4 to 7.1) caused expiratory activity in an internal intercostal muscle (IIM) during the first half of the expiratory phase (Ea). As the initial step in finding nerves or muscles firing during the second half of the expiratory phase (Eb), the patterns of activity in the glossopharyngeal, vagus and accessory nerves were examined in the present study. 2. Since the emerging motor rootlets of these three nerves (> 20; collected into about 10 bundles before the jugular foramen) are distributed in a continuous fashion from rostral to caudal levels of the brainstem, visual identification was impossible. Therefore, antidromic compound action potentials evoked by stimulation of the glossopharyngeal nerve (IX), the pharyngeal branch of the vagus nerve (PhX), the superior laryngeal nerve (SLN), the cervical vagus nerve (CX) and the accessory nerve (XI) were recorded from the peripheral stumps of the various rootlets. Nerve rootlets could be categorised into rostral, intermediate and caudal groups (rostIX-XI, intIX-XI, caudIX-XI). The rostIX-XI rootlets showed their largest potential on IX stimulation, while the intIX-XI and caudIX-XI rootlets showed their largest potentials on CX stimulation. The intIX-XI rootlets showed larger potentials on PhX and SLN stimulation than the caudIX-XI rootlets. 3. Activity was recorded simultaneously from the central stumps of the rootlets in the above three groups. Most rootlets showed inspiratory bursts. Under low pH conditions, all representatives of group rostIX-XI, most of intIX-XI and about half of caudIX-XI showed additional bursts during the Ea phase. Groups intIX-XI and caudIX-XI but not rostIX-XI also showed discrete bursts during the Eb phase in some preparations. In general, expiratory activity was prominent in intIX-XI. The spinal branch of XI showed no consistent respiratory activity. 4. Since the intIX-XI rootlets showed Eb bursts and large antidromic potentials on stimulation of PhX and SLN (which innervate the inferior pharyngeal constrictor muscle (IPC)), electromyograms were recorded from the rostral and caudal parts of IPC (rIPC and cIPC). Under low pH conditions, cIPC showed bursts during the Ea and Eb phases, while rIPC showed bursts predominantly during the Eb phase. 5. These results indicate that recording from rIPC would be a useful way of examining the neuronal mechanisms responsible for Eb phase activity.

Accessory Nerve↗
PubMed1999

Intraspinal schwannoma of the accessory nerve.

The second example of a schwannoma originating from the cervical portion of the accessory nerve is reported. The tumour was diagnosed by MRI and confirmed by surgery. The tumour was small and was located entirely within the cervical subarachnoid space without causing any detectable neurological deficit.

Accessory Nerve↗
PubMed2005

Meningioma of the accessory nerve extending from the jugular foramen into the parapharyngeal space.

A 35-year-old man presented with pain in the right shoulder and neck for 18 months. The neurological examination revealed complete accessory nerve palsy on the right side without further deficits. Magnetic resonance imaging showed a right parapharyngeal tumour expanding into the posterior fossa through the jugular foramen without dural attachment and absence of invasion into the middle ear cavity or internal auditory meatus. Intraoperative inspection disclosed a tumour originating from the accessory nerve. Histological diagnosis revealed a meningothelial meningioma with invasion of the epineural space. To the knowledge of the authors this is the first report of an accessory nerve meningioma in the jugular foramen associated with a posterior fossa component and extension into the parapharyngeal space.

Accessory Nerve Diseases↗
PubMed2003

Bilateral meningiomatous lesions of the spinal accessory nerves.

BACKGROUND: Meningiomas arising from cranial nerves with no dural attachment are exceedingly rare. The authors present a patient with bilateral meningiomatous lesions originating symmetrically from both spinal accessory nerves. CASE REPORT: A 61-year old woman presented with a one-year history of spinal ataxia and minimal left-sided motor impairment. Magnetic resonance imaging demonstrated two extrinsic lesions dorsolaterally of the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed the lesions arising from the spinal accessory nerves and in direct contact with the vertebral arteries. Histological investigation showed hypocellular fibrous lesions with proliferating meningothelial cells, psammoma bodies and immunoreactivity for vimentin, S-100 protein and epithelial membrane antigen. INTERPRETATION: To the authors' knowledge this is the first report of intradural tumours of the spinal accessory nerves not derived from Schwann cells and the first report of bilateral intracranial meningiomatous lesions without dural attachment.

Accessory Nerve Diseases↗
PubMed2006

Spinal accessory nerve function after neck dissections.

The aim of this study was to evaluate spinal accessory nerve function after functional neck dissection (FND) and radical neck dissection (RND) by monitoring the nerve with electromyographic (EMG) examinations. A prospective, double-blind, clinical study was undertaken in 21 patients (42 neck side dissections) operated on for head and neck malignant diseases, separated into two groups: 10 neck sides in the RND group and 32 neck sides in the FND group. Electromyographic examinations were performed pre-operatively and post-operatively in the third week and third and ninth months. Additionally, a questionnaire, modified from the neck dissection impairment index, was applied to all the patients in order to assess shoulder function in the ninth post-operative month. All patients had maximum EMG scores pre-operatively. Following the operation, motor amplitudes decreased in both groups. At the third post-operative month, amplitudes decreased to their lowest values. As expected, the decreases in amplitude and EMG score were more prominent in the RND group. Following reinnervation, the amplitudes of the trapezius motor response increased in the FND group but never reached pre-operative values (during the time of follow up). The FND group scores for pain, neck and shoulder stiffness, and disability in heavy object lifting, light object lifting and reaching overhead were significantly lower than those of the RND group. In FND, one aims to preserve anatomically the spinal accessory nerve, and it is presumed to be intact after the procedure. However, using EMG nerve function monitoring, our study revealed that profound spinal nerve injury was detected immediately after FND surgery, which tended to improve over subsequent months but had not regained its original function by the end of the ninth post-operative month.

Accessory Nerve Injuries↗
PubMed1985

Accessory nerve neurinoma mimicking a brain stem tumor on angiography: report of a case.

A case of accessory nerve neurinoma presenting with a so-called "intraaxial mass sign" on the angiograms is reported. The tumor originated from the intracranial portion of the accessory nerve and displaced the lateral medullary segment of the posterior inferior cerebellar artery posterolaterally. The displacement of the artery can be understood by the microanatomical relations.

Accessory Nerve↗
PubMed1999

The head stabilization reflex by stimulation of accessory nerve.

The head stabilization reflex (HSR) was described by a new technique of stimulating the accessory nerve and then the reflex muscle responses' were recorded electromyographically from the contralateral sternocleidomastoid muscle. Thirty-two normal control subjects and 22 patients with various neurological disorders were studied. The HSR obtained from the contralateral sternocleidomastoid muscle was very stable with a mean latency of about 45 ms and was regularly obtained by the supramaximal stimulation of the ipsilateral accessory nerve from the normal subjects. The HSR was absent in 9 out 11 patients with cerebellar syndrome. The HSR seemed to be a oligo-polysynaptic/plurosegmental reflex under the strong control of the cerebellum.

Accessory Nerve↗
PubMed1984

Shoulder pain and function after neck dissection with or without preservation of the spinal accessory nerve.

To compare the difference in the degree of pain and functional disability of the shoulder in patients who underwent neck dissection for the treatment of head and neck cancer, 23 patients with and 12 patients without spinal accessory nerve preservation were evaluated with a questionnaire and a physical examination. In addition, to determine what effect radiation treatment has on pain and shoulder disability, eight patients who had whole neck radiation but no neck dissection were similarly evaluated. The results of this study show that, on the average, neck dissection patients with their spinal accessory nerve preserved have less pain in their shoulders, less functional disability, and stronger results on their physical examination than did those with their spinal accessory nerve sacrificed. It was also found that the patients who received whole neck radiation treatment without neck dissection had little pain, infrequent and insignificant functional disability, and normal strength on physical examination.

Accessory Nerve↗
PubMed2005

[Transpositional anastomosis of C7 posterior root and spinal accessory nerve to reconstruct the trapezius muscle function].

OBJECTIVE: To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. METHODS: From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (> 3. 0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation. One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. RESULTS: One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90 degrees. The mean maximal abduction angle was more than 95 degrees. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade II in 7 cases and grade II in 3 cases. CONCLUSION: Transpositional anastomosis of the C7 posterior root to the spinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function after the cutting of C7.

Accessory Nerve↗
PubMed2002

Occupational therapy for accessory nerve palsy after radical neck dissection.

The subjects in this study were ten patients with accessory nerve palsy after radical neck dissection. All the primary diseases that accounted for radical neck dissection were malignant tumors located at the head or neck. Every patient received occupational therapy and underwent evaluations before and after the therapy. The data we collected included the existence of resting pain and motion pain, and the active and passive range of motion during shoulder flexion and abduction. The occupational therapy programs were not adequately effective for resting and motion pain, however, every patient gained independence for activities of daily living and housekeeping activities. The occupational therapy significantly improved the patient's shoulder elevation in all movements; although, the active abduction was always significantly poor compared with flexion. In the meantime, there were no significant differences between passive shoulder flexion and abduction at all times. We can therefore understand that the accessory nerve palsy especially affects active shoulder abduction induced by the trapezius paralysis. Occupational therapy is an effective treatment for the improvement of shoulder function, however, the occupational therapy has limited effectiveness for coping with the pain.

Accessory Nerve Diseases↗
PubMedDate not supplied

Spinal accessory nerve palsy: an unusual complication of rhytidectomy.

Rhytidectomy is a safe and effective procedure for rejuvenation of the aging face. Reported complication rates vary between 2.5% and 28%, and with proper management, longterm sequelae are unusual. Injury to the spinal accessory nerve is a rare but potentially debilitating complication of rhytidectomy. Afflicted patients present with dull, constant pain in the shoulder region which can be serve in nature. In addition, there is weakness of shoulder abduction and cosmetic deformity related to trapezius atrophy. Measures for conservative management include analgesics and physical therapy to strengthen the shoulder girdle. Nerve exploration is indicated for cases with documented denervation that do not respond to conservative treatment. A review of the English literature identified two previous case reports of spinal accessory nerve injury sustained during rhytidectomy. In this report, we present two additional cases and review current concepts regarding diagnosis, management, and prevention of this unusual complication of rhytidectomy.

Accessory Nerve↗
PubMed1987

Microsurgical repair of iatrogenic accessory nerve lesions in the posterior triangle of the neck.

Of ten patients with iatrogenic lesion of the accessory nerve in the posterior triangle of the neck, nine underwent secondary reconstructive surgery, with direct end-to-end nerve suture or with nerve grafting. In the six patients whose operation was performed within 4 months from the injury recovery was satisfactory, but the three with longer delay did not recover. Reconstructive surgery as soon as possible after the injury is advocated.

Accessory Nerve↗
PubMed1978

[Responses of accessory nerve nucleus motor neurons to stimulation by different sensory inputs].

Monosynaptic EPSPs in the cat accessory motoneurons were evoked by the stimulation of the cervical dorsal roots (C1 and C2). Responses of these units to the accessory nerve muscle rami stimulation were unstable and polysynaptic. It is supposed that the accessory muscles in the cat (m. sternocleidomastoideus and m. trapezius) receive proprioceptive innervation via the dorsal rami of the upper crevical nerves, and the function of accessory nerve is predominantly motor.

Accessory Nerve↗
PubMed2000

Surgical anatomy of the spinal accessory nerve and the trapezius branches of the cervical plexus.

BACKGROUND: A thorough understanding of the topographical anatomy of the spinal accessory nerve and the cervical plexus branches is a basic prerequisite for positive results when operating on the neck. OBJECTIVE: To give an exact description of the topographical and surgical anatomy of the spinal accessory nerve (SAN) and the trapezius branches of the cervical plexus. DESIGN: Anatomic analysis of the SAN and the trapezius branches of the cervical plexus. SETTING: The topographical anatomy of the SAN and the cervical plexus branches were studied in the anterior and posterior triangles of the necks of 46 perfusion-fixed human cadavers of both sexes, which ranged in age from 55 to 97 years (mean age, 83 years). RESULTS: The SAN can be identified on the posterior border of the sternocleidomastoid (SCM) muscle, 8.2 + 1.01 cm cranial to the clavicle. In 37% of cases, the SAN enters the posterior triangle of the neck dorsal to the SCM muscle, where it passes through the muscle in 63% of these cases. In the anterior triangle of the neck, the SAN crosses the internal jugular vein ventrally in 56% of the cases and dorsally in 44%. Regarding the cervical plexus, 1 trapezius branch could be found in 9% of the specimens, 2 in 61%, and 3 in 30%. None of the branches merged with the SAN medial to the anterior border of the trapezius muscle. In most cases, a tiny additional branch could be found arising from the SAN about 2 cm medial to the trapezius muscle. This branch enters the descendant part of the muscle approximately 2 to 3 cm cranial to the main nerve. CONCLUSIONS: Surprisingly, available data on topographical as well as surgical anatomy of the SAN and the trapezius branches of the cervical plexus are confusing and often wrong. The descriptions given herein can help to minimize the risk of injuring the SAN during neck surgery and preserve the additional innervation of the trapezius muscle granted by the rami trapezii of the cervical plexus.

Accessory Nerve↗