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PubMed1997

Experimental study on donor nerves for brachial plexus injury: comparison between the spinal accessory nerve and the intercostal nerve.

The spinal accessory nerve and intercostal nerves are widely used as donor nerves for neurotization in patients with brachial plexus injuries. However, the characteristic differences in reinnervation by the spinal accessory and intercostal nerves have not been investigated. The purpose of this study is to compare the resulting contractile properties of the biceps muscles following nerve-crossing procedures of spinal accessory nerve and intercostal nerves to the musculocutaneous nerves. In 10 beagle dogs, the spinal accessory nerve was used to reinnervate the left biceps muscle, and the second and third intercostal nerves were used to reinnervate the right biceps muscle. After 10 months, the reinnervated muscles were studied by measuring their force of contraction as well as by histochemical methods. Biceps muscles reinnervated by spinal accessory nerves (A transfers) acquired the properties of fast, fatigable muscles, whereas those reinnervated by intercostal nerves (IC transfers) acquired the properties of slow, fatigue-resistant muscles. Furthermore, histochemical studies showed that type II fibers were predominant in A transfers, whereas type I fibers were predominant in IC transfers. This study clearly demonstrates the differences between the spinal accessory nerve and intercostal nerves as donor nerves. This may lead us to select appropriate donor nerves for nerve-crossing procedures and free-muscle transfer depending on the desired functions to be reconstructed.

Accessory Nerve↗
PubMed2002

Anatomical evidence for the absence of a morphologically distinct cranial root of the accessory nerve in man.

The accessory nerve is conventionally described as having a cranial and spinal root. According to standard descriptions the cranial root (or part) is formed by rootlets that emerge from the medulla between the olive and the inferior cerebellar peduncle. These rootlets are considered to join the spinal root, travel with it briefly, then separate within the jugular foramen to become part of the vagus nerve. In 15 fresh specimens we exposed the posterior cranial fossa with a coronal cut through the foramen magnum and explored the course of each posterior medullary rootlet (PMR) arising from within the retro-olivary groove. We chose the caudal end of the olive as the landmark for the caudal end of the medulla. In all specimens every PMR that did not contribute to the glossopharyngeal nerve joined the vagus nerve at the jugular foramen. The distance between the caudal limit of the olive and the origin of the most caudal PMR that contributed to the vagus nerve ranged from 1-21 mm (mean = 8.8 mm). All rootlets that joined the accessory nerve arose caudal to the olive. The distance from the caudal limit of the olive and the most rostral accessory rootlet ranged from 1-15 mm (mean = 5.4 mm). We were unable to demonstrate any connection between the accessory and vagus nerves within the jugular foramen. Our findings indicate that the accessory nerve has no cranial root; it consists only of the structure hitherto referred to as its spinal root.

Accessory Nerve↗
PubMed2000

A simple method of identifying the spinal accessory nerve.

The spinal accessory nerve (nerve XI) constitutes a unique and readily encountered hazard in cutaneous and subcutaneous surgery of the head and neck. Presented is a simple method of using pinprick hyperaesthesia to accurately identify the course of this nerve. Delineating this nerve prior to performing surgery in the lateral neck and shoulder region is crucial to avoid the potentially disastrous complication of severing this nerve.

Accessory Nerve↗
PubMed1979

The surgical anatomy of the spinal accessory nerve and the internal branch of the superior laryngeal nerve.

Injury to the spinal accessory nerve may occur during conservation neck dissection. In supraglottic laryngectomy preservation of the internal branch of the superior laryngeal nerve has largely been ignored. Cadaver dissection and diagrams are used to review the surgical anatomy of these two structures. Particularly important are the relationship of the spinal accessory nerve to the sternocleidomastoid muscle, its interaction with the cervical plexus, and its superficial path inferiorly. Landmarks for the identification of the internal branch of the superior laryngeal nerve are indicated, and technique for preservation is described. An intact accessory nerve can be efficiently preserved thereby eliminating the shoulder syndrome. Significant sparing of the internal branch of the superior laryngeal nerve can be routinely accomplished as an aid in minimizing postoperative aspiration.

Accessory Nerve↗
PubMed2006

Improved technique for harvesting the accessory nerve for transfer in brachial plexus injuries.

OBJECTIVE: The accessory nerve is frequently used as a donor for nerve transfer in brachial plexus injuries. In currently available techniques, nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the nerve. We propose a technique for location and dissection of the accessory nerve between the deep cervical fascia and the trapezius muscle. METHODS: Twenty-eight patients with brachial plexus palsy had the accessory nerve surgically transplanted to the suprascapular nerve. To harvest the accessory nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The accessory nerve and its branches entering the trapezius muscle were identified. The accessory nerve was sectioned as distally as possible. To allow for accessory nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the accessory nerve was passed through this tunnel to the brachial plexus. RESULTS: In all of the cases, the accessory nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the accessory nerve with the suprascapular nerve was possible in all patients. CONCLUSION: The technique proposed here for harvesting the accessory nerve for transfer made its identification and dissection easier.

Accessory Nerve↗
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↗
PubMed1988

Stretch-induced spinal accessory nerve palsy.

Left spinal accessory nerve palsy occurred in a young man when he quickly turned his head to the right while his shoulders were pulled down by heavy hand-held objects. Electrophysiologic studies demonstrated partial axonotmesis of the spinal accessory nerve branches innervating the sternocleidomastoid and upper and middle trapezius and complete axonotmesis of spinal accessory branches to the lower trapezius. There was a separate, although functionally minor, cervical plexus innervation of the lower trapezius.

Accessory Nerve Injuries↗
PubMed2006

[Clinical anatomy measurement of accessory nerve in neck dissection].

OBJECTIVE: To investigate the relations between accessory nerve and its surrounding structures. METHODS: One hundred and thirty six patients were divided into two groups: has or has no neck surgical history. Neck dissection were performed and the four distance were measured simultaneously. The distance of accessory nerve and the great auricular nerve going out the posterior edge of sternocleidomastoid muscle; the distance of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint; the distance of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to sternoclavicular articulation; the distance of the point accessory nerve enter trapezius muscle to clavicular midpoint. RESULTS: In no neck dissection group, the point accessory nerve going out sternomastoid muscle were supra the point of great auricular nerve going out the sternomastoid muscle, the average length of two points is (0. 61 +/- 0. 35) cm , the significance has not observed between genders (P > 0.05), however, there has significant difference between two groups of has or has no neck surgical history (P < 0.05). 88.2% (112/127) accessory nerve going out supra the great auricular within 1.0 cm, 11.8% (15/127) within 1.0 approximately 2.0 cm. 67.7% (86/127) accessory nerve adopt branch from cervical plexus before entering trapezius. The distances of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint and to sternoclavicular articulation were significant relative not with before neck surgical history but gender. The distance of the point accessory nerve enter trapezius muscle to clavicular midpoint is (4.96 +/- 0.78) cm, it has no difference both before neck surgical history and gender (P > 0.05). CONCLUSION: In no neck surgical history group,both of the distance that accessory nerve and the great auricular nerve going out the posterior edge of sternocleidomastoid muscle and the point accessory nerve enter trapezius muscle to clavicular midpoint were helpful for search accessory nerve in surgery. But in patients who have neck surgical history or great auricular have been injured, accessory nerve could be looked for associating with the distances of the point accessory nerve going out the posterior edge of sternocleidomastoid muscle to clavicular midpoint and to sternoclavicular articulation; the distance of the point accessory nerve enter trapezius muscle to clavicular midpoint.

Accessory Nerve↗
PubMed1990

Reinnervation of avulsed brachial plexus using the spinal accessory nerve.

The use of the accessory nerve as a donor is one of the possibilities for the reinnervation of the brachial plexus in cases of paralysis due to root avulsion. In this paper, an analysis of the reinnervation of the musculocutaneous or axillary nerve using the spinal accessory nerve is made on 13 cases, 8 of total and 5 of upper partial avulsion. In all cases, Allieu's technique was used, but in seven cases reinnervation was supplemented by upper intercostal nerves when there was total avulsion and/or by the medial pectoral nerve when there was partial avulsion. The methods are discussed and compared with the intercostobrachial anastomosis.

Accessory Nerve↗
PubMed2005

[Management of iatrogenic lesions of the spinal accessory nerve].

Lesions of the spinal accessory nerve are usually iatrogenic, especially after lymph node extirpation on the neck. Between 1994 and 2003, 31 patients were operated on in the Neurosurgical Department of the University of Ulm for iatrogenic lesions of the XIth cranial nerve. Of 31 patients, 22 had undergone a previous lymph node extirpation, 2 had been injured during a selective peripheral denervation for spasmodic torticollis, and the other 7 patients by different causes. The neurosurgical intervention was performed 0-19 months after trauma (mean 7.2 months). All patients showed paresis/atrophy of the trapezius muscle, and the abduction of the shoulder was markedly reduced. Additional neck and/or shoulder pain was present in 29 of 31 cases. In seven cases, the nerve was compressed by scar tissue and subsequently treated by external neurolysis. Ten patients underwent an end-to-end anastomosis; autologous sural nerve grafting was necessary in 13 cases. After a mean follow-up of 12.6 months, 7 of 31 patients completely recovered. Of 31 patients, 19 experienced partial relief of pain and weakness. Only five patients remained unchanged. The clinical findings after autologous nerve grafting, end-to-end reconstruction, or external neurolysis did not show any significant differences. Microsurgical reconstruction of iatrogenic injury of the spinal accessory nerve is very promising if the interval between trauma and surgical revision is less than 6 months. Up to 12 months, partial recovery can be achieved. Outcome after longer delay is unsatisfactory.

Accessory Nerve↗
PubMedDate not supplied

Benign solitary nerve sheath tumors of the spinal accessory nerve in the posterior triangle of the neck. Report of two cases.

A case of solitary schwannoma and one of solitary neurofibroma originating from the spinal accessory nerve in the posterior triangle of the neck are described. Location of such neoplasms in this region is exceptional. The authors emphasize the importance of accurately enucleating the mass; when it is impossible to preserve the continuity of the neural pathway, nerve repair should be considered.

Accessory Nerve↗
PubMedDate not supplied

Studying nerve conduction velocity and latency of accessory nerve motor potential in normal persons.

In order to standardize Nerve Conduction Velocity(NCV), proximal and distal latency and amplitude of motor conduction in intact accessory nerves, a cross-sectional, descriptive-analytic study was done on 60 healthy persons with strict attention to number of cases, distance between stimulation sites, temperature and age. The average results were as follows: Distal latency 2.54 milliseconds (msec.) (2.25-2.83), Proximal latency 3.64 msec. (3.34-3.94), Amplitude 13.76 millivolts (mv.) (8.56-18.96) and NCV 67.98 m/s (56.95-79.01). The average latencies in women were significantly less than men, on both sides which can be due to higher superficial skin temperature in women.

Accessory Nerve↗
PubMed1982

Accessory nerve palsy: an uncommon etiology.

Accessory nerve palsy due to surgery in the anterior triangle of the neck is uncommon. Two such cases 1, after a carotid endarterectomy and the other after rhytidectomy, are described here. Both cases were treated with analgesics and physical therapy. Followup evaluation after 1 year revealed complete clinical and electrophysiologic recovery in only the first case. Recognizing accessory nerve palsy after surgical procedures in the necks is emphasized as important for proper management. An attempt is made to explain the reason for lack of improvement in the second case.

Accessory Nerve↗
PubMed1999

Malignant peripheral nerve sheath tumour of the spinal accessory nerve.

A 50-year-old man presented with a left-sided neck mass. Clinical examination revealed a large fluctuant 7 cm x 7 cm mass in the left posterior triangle. Magnetic resonance imaging (MRI) revealed an encapsulated soft tissue lesion. He underwent exploration of the neck and a 14 cm by 8 cm mass enfolding the accessory nerve was identified and completely excised. Histological examination of the surgical specimen showed features in keeping with a malignant peripheral nerve sheath tumour (MPNST). We present the clinical and pathological features of this condition.

Accessory Nerve Diseases↗
PubMed1987

Accessory nerve injury during carotid endarterectomy.

Injury to the accessory nerve (cranial nerve XI) during carotid endarterectomy is rare; to date only three cases have been reported in the literature. Traction on the sternocleido-mastoid muscle was the proposed mechanism of injury in all three cases. Four cases of accessory nerve palsy occurred in 850 carotid endarterectomies performed between 1978 and 1986 at this institution, an incidence of 0.47%. All four patients had classic signs and symptoms of accessory nerve injury, which developed between 20 and 60 days after operation. The three most recent cases were examined specifically for accessory nerve injury in the immediate postoperative period and exhibited normal trapezius function. None had any other central nervous system dysfunction. Two of these patients regained full accessory nerve function and the most recent case is showing signs of reinnervation with conservative therapy. Isolated central nervous system and spontaneous accessory nerve palsies are exceptionally rare, and since any traction injury or transection should have been detected by postoperative examinations in three of four patients, we propose surgical scar formation as a mechanism of accessory nerve palsy after carotid endarterectomy. If such a palsy develops in the postoperative period, we recommend conservative therapy.

Accessory Nerve Injuries↗
PubMed1999

Spinal accessory nerve injury.

Injury to the spinal accessory nerve can lead to dysfunction of the trapezius. The trapezius is a major scapular stabilizer and is composed of three functional components. It contributes to scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to injury. Iatrogenic injury to the nerve after a surgical procedure is one of the most common causes of trapezius palsy. Dysfunction of the trapezius can be a painful and disabling condition. The shoulder droops as the scapula is translated laterally and rotated downward. Patients present with an asymmetric neckline, a drooping shoulder, winging of the scapula, and weakness of forward elevation. Evaluation should include a complete electrodiagnostic examination. If diagnosed within 1 year of the injury, microsurgical reconstruction of the nerve should be considered. Conservative treatment of chronic trapezius paralysis is appropriate for older patients who are sendentary. Active and healthy patients in whom 1 year of conservative treatment has failed are candidates for surgical reconstruction. Studies have shown the Eden-Lange procedure, in which the insertions of the levator scapulae, rhomboideus minor, and rhomboideus major muscles are transferred, relieves pain, corrects deformity, and improves function in patients with irreparable injury to the spinal accessory nerve.

Accessory Nerve↗
PubMed2001

Intradural anastomoses between the accessory nerve and the posterior roots of cervical nerves: their clinical significance.

This study was performed to identify the anastomoses between the accessory nerve and the posterior roots of cervical nerves below the level of C1 segment, and to evaluate their clinical significance. One hundred spinal cord sides of Koreans were studied under the surgical microscope. In order to trace the posterior root of a cervical nerve after anastomosis with the accessory nerve, or the bridging fibers between the accessory nerve and the cervical posterior roots, the accessory nerves with the posterior roots and the bridging fibers were stained with osmium tetroxide. The anastomosis was classified into five types, according to whether the accessory nerve and the cervical posterior root crossed each other, and also according to the site of the bridging fiber between them. The bridging fibers in the most common type of anastomoses were observed to connect the posterior roots of a cervical nerve with the spinal rootlet of the accessory nerve. The possibility that the motor fibers of accessory nerve from the spinal cord may innervate the trapezius muscle through the cervical nerve, was discussed.

Accessory Nerve↗