Surgical Outcomes of 111 Spinal Accessory Nerve Injuries

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1106-1113 ◽  
Author(s):  
Daniel H. Kim ◽  
Yong-Jun Cho ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Surgical Outcomes ◽  
Neck Surgery ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
State University ◽  
Nerve Injuries ◽  
Spinal Accessory ◽  
Louisiana State University ◽  
Operative Exploration ◽  
Grade 3

Abstract OBJECTIVE Iatrogenic injury to the spinal accessory nerve is not uncommon during neck surgery involving the posterior cervical triangle, because its superficial course here makes it susceptible. We review injury mechanisms, operative techniques, and surgical outcomes of 111 surgical repairs of the spinal accessory nerve. METHODS This retrospective study examines clinical and surgical experience with spinal accessory nerve injuries at the Louisiana State University Health Sciences Center during a period of 23 years (1978–2000). Surgery was performed on the basis of anatomic and electrophysiological findings at the time of operation. Patients were followed up for an average of 25.6 months. RESULTS The most frequent injury mechanism was iatrogenic (103 patients, 93%), and 82 (80%) of these injuries involved lymph node biopsies. Eight injuries were caused by stretch (five patients) and laceration (three patients). The most common procedures were graft repairs in 58 patients. End-to-end repair was used in 26 patients and neurolysis in 19 patients if the nerve was found in continuity with intraoperative electrical evidence of regeneration. Five neurotizations, two burials into muscle, and one removal of ligature material were also performed. More than 95% of patients treated by neurolysis supported by positive nerve action potential recordings improved to Grade 4 or higher. Of 84 patients with lesions repaired by graft or suture, 65 patients (77%) recovered to Grade 3 or higher. The average graft length was 1.5 inches. CONCLUSION Surgical exploration and repair of spinal accessory nerve injuries is difficult. With perseverance, however, these patients with complete or severe deficits achieved favorable functional outcomes through operative exploration and repair.

scholarly journals Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures

2015 ◽  
Vol 23 (4) ◽  
pp. 518-525 ◽  
Author(s):  
Sang Hyun Park ◽  
Yoshua Esquenazi ◽  
David G. Kline ◽  
Daniel H. Kim
Keyword(s):  
Lymph Node ◽  
Surgical Outcomes ◽  
Lymph Node Biopsy ◽  
Health Science ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Science Center ◽  
Spinal Accessory ◽  
Node Biopsy ◽  
Grade 3

OBJECT Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODS This retrospective study examines the authors’ clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8–44 months). RESULTS Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. CONCLUSIONS SAN injuries present challenges for surgical exploration and repair because of the nerve’s size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.

Contralateral spinal accessory nerve for ipsilateral neurotization of branches of the brachial plexus: a cadaveric feasibility study

2011 ◽  
Vol 114 (6) ◽  
pp. 1538-1540 ◽  
Author(s):  
R. Shane Tubbs ◽  
Martin M. Mortazavi ◽  
Mohammadali M. Shoja ◽  
Marios Loukas ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Brachial Plexus ◽  
Spinous Process ◽  
Trapezius Muscle ◽  
Nerve Transfer ◽  
Average Diameter ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Injuries ◽  
Potential Donor ◽  
Spinal Accessory

Object Additional nerve transfer options are important to the peripheral nerve surgeon to maximize patient outcomes following nerve injuries. Potential regional donors may also be injured or involved in the primary disease. Therefore, potential contralateral donor nerves would be desirable. To the authors' knowledge, use of the contralateral spinal accessory nerve (SAN) has not been explored for ipsilateral neurotization procedures. In the current study, therefore, the authors aimed to evaluate the SAN as a potential donor nerve for contralateral nerve injuries by using a novel technique. Methods In 10 cadavers, the SAN was harvested using a posterior approach, and tunneled subcutaneously to the contralateral side for neurotization to various branches of the brachial plexus. Measurements were made of the SAN available for transfer and of its diameter. Results The authors found an SAN length of approximately 20 cm (from transition of upper and middle fibers of the trapezius muscle to approximately 2–4 cm superior to the insertion of the trapezius muscle onto the spinous process of T-12) available for nerve transposition. The average diameter was 2.5 mm. Conclusions Based on these findings, the contralateral SAN may be considered for ipsilateral neurotization to the suprascapular and axillary nerves.

Considering the spinal accessory nerve in head and neck surgery

1985 ◽  
Vol 150 (4) ◽  
pp. 491-494 ◽  
Author(s):  
John R. Saunders ◽  
Richard M. Hirata ◽  
Darrell A. Jaques
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory

Spinal Accessory Nerve Injury

2018 ◽  
Author(s):  
Kevin Chan ◽  
Rishi Dihr ◽  
Michael Fox
Keyword(s):  
Differential Diagnosis ◽  
Nerve Repair ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Glenohumeral Instability ◽  
Spinal Accessory ◽  
Operative Exploration ◽  
Brachial Neuritis ◽  
Neck Fracture ◽  
Ancillary Studies

Spinal accessory nerve (SAN) injuries can be idiopathic or iatrogenic. Providers who understand the essential anatomy of the SAN can direct the history, physical exam, and ancillary studies to localize the lesion, while considering the differential diagnosis. The differential diagnosis includes both traumatic and atraumatic causes, including penetrating or blunt trauma to the neck, fracture malunion, glenohumeral instability, brachial neuritis, progressive neuromuscular disease, and cerebrovascular accident. The chapter discusses the timing of, and indications for, operative exploration, with or without nerve repair, as well as the details of the surgical procedure. The authors provide instructive pearls for initial management, establishing patient expectations, and potential complications.

Spinal Accessory Nerve Function following Neck Dissection

1988 ◽  
Vol 97 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Francesco Zibordi ◽  
Federico Baiocco ◽  
Cristina Bascelli ◽  
Artilio Bini ◽  
Alfredo Canepa
Keyword(s):  
Neck Dissection ◽  
Radical Neck Dissection ◽  
Trapezius Muscle ◽  
Neck Surgery ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Nerve Function ◽  
Spinal Accessory ◽  
Muscle Testing

Spinal accessory nerve (SAN) function was evaluated by electromyography (EMG) and muscle testing in 36 patients who underwent neck dissection with SAN preservation. The results emphasized that SAN function was relatively good after conservative neck surgery. Muscle testing findings showed better function than did EMC findings. After surgery the trapezius muscle functioned more efficiently than the sternocleidomastoid (SCM) muscle probably because of the more traumatic surgical handling of both the SCM muscle and its SAN branch. In order to obtain the functional advantages of SAN preservation, the authors suggest that the conservative procedure in radical neck dissection be used whenever warranted by oncologic diagnosis.

scholarly journals Spinal accessory nerve to triceps muscle transfer using long autologous nerve grafts for recovery of elbow extension in traumatic brachial plexus injuries

2018 ◽  
Vol 129 (4) ◽  
pp. 1041-1047 ◽  
Author(s):  
Liselotte F. Bulstra ◽  
Nadia Rbia ◽  
Michelle F. Kircher ◽  
Robert J. Spinner ◽  
Allen T. Bishop ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Elbow Extension ◽  
Motor Branch ◽  
Spinal Accessory ◽  
Triceps Muscle ◽  
Long Head ◽  
Grade 3

OBJECTIVEReconstructive options for brachial plexus lesions continue to expand and improve. The purpose of this study was to evaluate the prevalence and quality of restored elbow extension in patients with brachial plexus injuries who underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle with an intervening autologous nerve graft and to identify patient and injury factors that influence functional triceps outcome.METHODSA total of 42 patients were included in this retrospective review. All patients underwent transfer of the spinal accessory nerve to the motor branch of the radial nerve to the long head of the triceps muscle as part of their reconstruction plan after brachial plexus injury. The primary outcome was elbow extension strength according to the modified Medical Research Council muscle grading scale, and signs of triceps muscle recovery were recorded using electromyography.RESULTSWhen evaluating the entire study population (follow-up range 12–45 months, mean 24.3 months), 52.4% of patients achieved meaningful recovery. More specifically, 45.2% reached Grade 0 or 1 recovery, 19.1% obtained Grade 2, and 35.7% improved to Grade 3 or better. The presence of a vascular injury impaired functional outcome. In the subgroup with a minimum follow-up of 20 months (n = 26), meaningful recovery was obtained by 69.5%. In this subgroup, 7.7% had no recovery (Grade 0), 19.2% had recovery to Grade 1, and 23.1% had recovery to Grade 2. Grade 3 or better was reached by 50% of patients, of whom 34.5% obtained Grade 4 elbow extension.CONCLUSIONSTransfer of the spinal accessory nerve to the radial nerve branch to the long head of the triceps muscle with an interposition nerve graft is an adequate option for restoration of elbow extension, despite the relatively long time required for reinnervation. The presence of vascular injury impairs functional recovery of the triceps muscle, and the use of shorter nerve grafts is recommended when and if possible.

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