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At least 145 records · Page 8Linked to original sources
PubMed1996

[Radical neck dissection and the possibility of complications: surgical technique].

Based on 15 pictures the technique of radical neck dissection is presented with particular attention to the topography of the neck. Steps by steps the possibility of complications is considered. During the operation the mandible branches of the facial nerve, vagus nerve, hypoglossal nerve, phrenic nerve, accessory nerve, shoulder plexus, cervical plexus, sympathetic trunk can be injured as well as the jugular vein, carotid artery, occipital artery, thoracic duct. The critical moments for generation of these complications are indicated.

Cranial Nerves↗
PubMed1993

Face and neck neurogenic neoplasms.

Surgeons should be aware that any mass in the region of the cranial nerves, brachial plexus, cervical sympathetic plexus, or a major peripheral nerve can be of neurogenic origin. Solitary neurogenic tumors of the head and neck can simulate metastatic masses or congenital lesions. If they are resected unrecognized and/or without regard to their nerve origin, major and permanent nerve defects can unnecessarily occur. Thirty-two patients, 16 males and 16 females, ranging in age from 5 to 69 years, had 33 extracranial solitary neurogenic neoplasms resected. The nerves involved were the cervical sympathetic plexus in 7 patients, branchial plexus in 6, spinal accessory nerve in 5, vagus nerve in 4, hypoglossal nerve in 3, facial nerve in 2, and 6 other nerves in 1 patient each. The technique is to dissect out the neurilemoma without destroying the nerve sheath or nerve trunk. Despite careful dissection, the four patients with masses of the vagus nerve had permanent ipsilateral cord paralysis.

Adolescent↗
PubMed1987

Interscalene block anesthesia for shoulder surgery.

One hundred patients had major shoulder surgery with interscalene brachial and cervical plexus block anesthesia. Successful anesthesia was obtained by using this method in 82 patients. Failure was the result of incomplete anesthesia in 16 patients or the presence of a complication. Complications from high blood levels of anesthetic included loss of consciousness and respiratory depression in three patients and seizure in one. The block lasted a mean of eight hours, decreasing the need for postoperative analgesic medications. No postoperative medical complication developed. Ninety-one percent of the patients with successful blocks were satisfied with the procedure.

Adult↗
PubMed1979

Clinical report: interscalene block for shoulder operations.

Administration of adequate volumes of local anaesthetic through a single injection into the interscalene space produces blockade of both the brachial and cervical plexuses. A report of 2 patients who underwent operative repair of recurrent dislocation of the shoulder under interscalene block is presented. The advantages and disadvantages of the block for surgery around the shoulder region, and the possible complications are discussed.

Adult↗
PubMed1980

Radiation-induced malignant and atypical peripheral nerve sheath tumors.

The reported peripheral nerve complications of therapeutic irradiation in humans include brachial and lumbar plexus fibrosis and cranial and peripheral nerve atrophy. We have encountered 9 patients with malignant (7) and atypical (2) peripheral nerve tumors occurring in an irradiated site suggesting that such tumors represent another delayed effect of radiation treatment on peripheral nerve. The neoplasms appeared 4 to 41 years following radio-therapy, at a time when the patients (6 females and 3 males) were 16 to 70 years old and cured of their original tumors. Eight patients had received irradiation to treat malignant disease; the ninth had a benign condition. The sites of peripheral nerve tumor were the brachial plexus in 5, cervical plexus in 1, lumbar plexus in 2, and retroperitoneum in 1. Eight patients presented with painful masses, and in 6 of the 8 there was a progressive neurological deficit. Seven patients died with metastases within two years of diagnosis. In all instances the radio-therapy was within an acceptable radiation dosage, yet 3 patients developed local radiation-induced skin and bony abnormalities. In 3 patients there were either clinical signs or a family history of von Recklinghausen disease, but the malignant peripheral nerve sheath tumors developed only in the radiation port. Animal studies support the clinical observation that malignant peripheral nerve sheath tumors can occur as a delayed effect of irradiation. Other etiological mechanisms, including an increased risk of second primaries in cancer patients and a genetic predisposition to peripheral nerve tumors, may also play a role.

Adolescent↗
PubMed2005

[Permanent local nerve injuries after carotid endarterectomy].

UNLABELLED: Functional assessment of nerves, especially motor rami of cranial nerves, in patients at postoperative period after carotid endarterectomy (CEA), is particularly important in case of necessity of contralateral carotid artery surgery. Bilateral damage to recurrent laryngeal or hypoglossal nerve is a potentially life-threatening complication. Sensory disturbances due to intraoperative injuries of cervical plexus branches may cause residual discomfort in numerous patients. The aim of this study was the assessment and comparison of frequency of persistent (for more than 12 months postoperatively) manifestations of cranial and cervical nerves injuries in patients after CEA performed either in the standard or eversion technique. A prospective study evaluating cranial and cervical nerves dysfunction after carotid endarterectomies in 144 out of 193 patients operated on from January 1999 until June 2001 was undertaken at the Department of General and Vascular Surgery, Pomeranian Medical University in Szczecin, Poland. CEA was performed in the standard way (i.e. by primary closure) in 92 patients, while 52 others were operated on by eversion technique. Neurological examination with careful functional assessment of cranial nerves: V, VII, IX, X, XII and cervical plexus, was performed according to a standard protocol within two follow-up periods: 3 to 6 and 12 to 18 months after discharge from the hospital. RESULTS: Dysfunction of recurrent laryngeal nerve and hypoglossal nerve were registered 12 to 18 months after CEA with similar incidence of 1.4%. There was no sign of residual damage to other cranial nerves. Sensory disturbances in the area supplied by cervical plexus, mainly transverse cervical and greater auricular nerve, were diagnosed in 26% of patients. There were no statistically significant differences in local neurological complication rates between patients operated on according to standard and eversion procedures. CONCLUSIONS: 1. Permanent damage of cranial nerves refers to small group of patients after carotid endarterectomy and concern predominantly recurrent laryngeal nerve and hypoglossal nerve. 2. Majority of local neurological complications are injuries to cervical plexus branches. 3. Eversion carotid endarterectomy is not related to higher incidence of local neurological deficits compared to standard procedure.

Aged↗
PubMed2005

[Carotid-surgery in ultrasound-guided anesthesia of the regio colli lateralis].

OBJECTIVE: Carotid endarterectomy significantly reduces the risk of stroke in patients with symptomatic and asymptomatic carotid artery stenosis. An increasing number of interventions in carotid surgery are performed under regional anesthesia in conscious patients. Carotid endarterectomy in local anesthesia requires block of the cervical nerves C2-C4, which may be accomplished in different ways. The most frequent method of regional anesthesia in carotid surgery is a combined block of profunda and superficial cervical plexus (by using a nerve stimulator). Ultrasound is frequently used in anesthesia for venous access and peripheral nerve block. By ultrasound, it is possible to visualize puncture needle and spread of local anesthetics at the correct position for block of cervical plexus in carotid surgery. The aim of the case reports was to demonstrate the effectiveness of using ultrasound for regional anesthesia in carotid surgery. METHOD: At the level of carotid bifurcation, scalene muscles were visualized by ultrasound (10-MHz-transducer). At this position, a puncture needle was inserted in the beam of ultrasound. Between the anterior scalene and the sternocleidomastoid muscles the local anesthetics were injected (10 ml prilocaine 1 %, 20 ropivacaine 0.375 %). In addition, superficial cervical plexus was performed by subcutaneous injection (10 ml prilocaine 1 %, 40 ropivacaine 0.375 %). Sedation was performed by application of remifentanil (max. 0.02 microg/kg/min), as needed. RESULTS: Ultrasound guided cervical block was performed in 29 patients. In all cases cervical plexus block was complete. A conversion to general anesthesia during operation was not necessary in any case. CONCLUSION: Ultrasound presents an alternative to cervical block using nerve stimulation, especially in patients with anatomical abnormalities. The method proves to be effective and may improve the approach to profundeal cervical plexus.

Aged↗
PubMedDate not supplied

[How many interscalene blocks are there? Reflections on 109 cases studied with various techniques].

The effects of interscalene block were studied on 109 patients undergoing upper extremity elective orthopaedic surgery. Blocks were performed in a non-randomized manner with three different techniques, the site where anaesthetic solution was injected being the main distinguishing mark. The anaesthetic solution was injected into the interscalenic compartment both in the case of patients where classic technique had been carried out and in the group where the nerve stimulator had been used. In the "double needle" technique group, on the contrary, the anaesthetic solution was injected close to the vertebral column. The spread of analgesia involves the caudal portion of the cervical plexus and the cranial portion of the brachial plexus, but with the cervical plexus is almost certain to be involved, the brachial is not. Block outcome was related to the surgical procedure (surgery or orthopaedic manipulation), the site of surgery, paraesthesia elicitation, prolonged surgery and height, weight, age and sex of patients. Results also different according to the technique used. When the anaesthetic solution was injected close to the vertebral column analgesic cover was more widespread and lesser amounts of anaesthetic needed. When the block was performed within the interscalenic compartment, the analgesic cover was usually restricted to the area supplied by the primary superior trunk of the brachial plexus. The different results were explained by the presence of fibrous sheaths within the interscalenic compartment limiting spread of the anaesthetic, which are absent close to the vertebral column. Therefore two types of interscalene block were postulated: an intrascalene or troncular block within the interscalenic compartment and a radicular or paravertebral block close the vertebral column.

Adolescent↗
PubMed2006

T1- and T2-weighted fast spin-echo imaging of the brachial plexus and cervical spine with IDEAL water-fat separation.

PURPOSE: To compare the iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) method with fat-saturated T1-weighted (T1W) and T2W fast spin-echo (FSE) and short-TI inversion recovery (STIR) imaging of the brachial plexus and cervical spine. MATERIALS AND METHODS: Images acquired at 1.5T in five volunteers using fat-saturated T1W and T2W FSE imaging and STIR were compared with T1W and T2W IDEAL-FSE images. Examples of T1W and T2W IDEAL-FSE images acquired in patients are also shown. RESULTS: T1W and T2W IDEAL-FSE demonstrated superior fat suppression (P<0.05) and image quality (P<0.05), compared to T1W and T2W fat-saturated FSE, respectively. SNR performance of T1W-IDEAL-FSE was similar to T1W FSE in the spinal cord (P=0.250) and paraspinous muscles (P=0.78), while T2W IDEAL-FSE had superior SNR in muscle (P=0.02) and CSF (P=0.02), and marginally higher cord SNR (P=0.09). Compared to STIR, T2W IDEAL-FSE demonstrated superior image quality (P<0.05), comparable fat suppression (excellent, P=1.0), and higher SNR performance (P<0.001). CONCLUSION: IDEAL-FSE is a promising method for T1W and T2W imaging of the brachial plexus and cervical spine.

Adipose Tissue↗
PubMed2001

Surgical anatomy of spinal accessory nerve: is trapezius functional deficit inevitable after division of the nerve?

The course of spinal accessory nerve in the posterior triangle, the innervation of the sternocleidomastoid and trapezius muscles and the contributions from the cervical plexus were studied in 20 cadaveric dissections. The nerve was most vulnerable to iatrogenic injuries after leaving the sternocleidomastoid. Direct innervation of trapezius by cervical plexus branches was noted in five dissections, whereas connections between the cervical plexus and the spinal accessory nerve were observed in 19 dissections. These were usually under the sternocleidomastoid (proximal to the level of division of the nerve in nerve transfer procedures). Although the contribution from the cervical plexus to trapezius innervation is considered minimal, trapezius function can be protected in neurotization procedures by transecting the spinal accessory nerve distal to its branches to the upper position of trapezius.

Accessory Nerve↗
PubMed2000

Complications from regional anaesthesia for carotid endarterectomy.

The complications of carotid endarterectomy (CEA) under cervical plexus blockade have yet to be fully evaluated. Two different cases are presented; both patients suffered sudden collapse following superficial and deep cervical plexus block in preparation for CEA. The causes, presenting signs and differential diagnoses are discussed. The safest cervical plexus anaesthetic block technique has not yet been established.

Aged↗