Surgical challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle: functional or structural?

2010 ◽  
Vol 12 (1) ◽  
pp. 22-24 ◽  
Author(s):  
R. Shane Tubbs ◽  
William Stetler ◽  
Robert G. Louis ◽  
Ankmalika A. Gupta ◽  
Marios Loukas ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Histological Analysis ◽  
Cranial Nerves ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Posterior Triangle ◽  
Structural Forces ◽  
Injury And Repair ◽  
Insight Into

Object The spinal accessory nerve (SAN) has been reported to have a distinctly coiled appearance in its course through the posterior cervical triangle of the neck. As this is unusual compared with other peripheral nerves including the cranial nerves, the present histological analysis was performed to further elucidate the reason for this anatomy with potential application in nerve injury and repair. Methods Ten adult cadavers underwent dissection of the neck. The SAN was harvested proximally and within the posterior cervical triangle. For comparison with other cranial nerves within the neck, the cervical vagus and hypoglossal nerves were also harvested. All nerves underwent histological analysis. Additionally, 2 human fetuses (11 and 20 weeks' gestation) underwent examination of the SAN in the posterior cervical triangle, and 3 randomly selected specimens were submitted for electromicroscopy. Results All SANs were found to have a straight gross configuration proximal to the posterior triangle and a coiled appearance within this geometrical area. Histologically, no differences were identified for the SAN in these 2 locations (that is, proximal to and within the posterior cervical triangle). The histology of the SAN both with routine analysis and electron microscopy was similar in both regions and to nerves used as controls (for example, vagus and hypoglossal nerves). Interestingly, both fetal specimens were found to have coiled SANs in the posterior cervical triangle. Conclusions Based on this study, it appears that the tortuous course of the SAN in the posterior triangle arises from functional as opposed to structural forces. It is hoped that this analysis will provide some insight into the nature behind the morphology observed in the SAN within the posterior cervical triangle and aid in future investigations regarding its injury. Moreover, such a coiled nature of this nerve may assist the neurosurgeon in identifying it during, for example, neurotization procedures.

The cranial nerves of three species of sea snakes

1987 ◽  
Vol 65 (9) ◽  
pp. 2236-2240 ◽  
Author(s):  
Bruce A. Young
Keyword(s):  
Cranial Nerves ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Sea Snakes

A generalized description is given of the form and peripheral distribution of all cranial nerves of Hydrophis melanocephalus, Lapemis hardwickii, and Aipysurus eydouxii. Results presented here agree with the studies of Auen and Langebartel (Auen, E. L., and Langebartel, D. A. 1977. J. Morphol. 154(2): 205–222) regarding the presence of the ocular trunk and the absence of the spinal accessory nerve, and differ from those reported by Agarwal and Sharma (Agarwal, P. N., and Sharma, S. 1979. Indian J. Zool. 7(1): 23–34).

Surgical Anatomy of Spinal Accessory Nerve: Is Trapezius Functional Deficit Inevitable after Division of the Nerve?

2001 ◽  
Vol 26 (2) ◽  
pp. 137-141 ◽  
Author(s):  
Z. H. DAILIANA ◽  
H. MEHDIAN ◽  
A. GILBERT
Keyword(s):  
Nerve Transfer ◽  
Surgical Anatomy ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Cervical Plexus ◽  
Spinal Accessory ◽  
Iatrogenic Injuries ◽  
Functional Deficit ◽  
Posterior Triangle ◽  
Transfer Procedures

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.

scholarly journals Schwannomatosis of the Spinal Accessory Nerve: A Case Report

2019 ◽  
Vol 14 (01) ◽  
pp. e9-e13
Author(s):  
Ramin Morshed ◽  
Anthony Lee ◽  
Young Lee ◽  
Cynthia Chin ◽  
Line Jacques
Keyword(s):  
Case Report ◽  
Genetic Screening ◽  
Rare Case ◽  
Clinical Presentation ◽  
Cranial Nerves ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Genetic Aberration ◽  
Lower Cranial Nerves

AbstractSchwannomatosis is a distinct syndrome characterized by multiple peripheral nerve schwannomas that can be sporadic or familial in nature. Cases affecting the lower cranial nerves are infrequent. Here, the authors present a rare case of schwannomatosis affecting the left spinal accessory nerve. Upon genetic screening, an in-frame insertion at codon p.R177 of the Sox 10 gene was observed. There were no identifiable alterations in NF1, NF2, LZTR1, and SMARCB1. This case demonstrates a rare clinical presentation of schwannomatosis in addition to a genetic aberration that has not been previously reported in this disease context.

scholarly journals The Relation of the Extracranial Spinal Accessory Nerve to the Sternocleidomastoid Muscle and the Internal Jugular Vein

2019 ◽  
Vol 12 (2) ◽  
pp. 108-111 ◽  
Author(s):  
ThomasMombo Amuti ◽  
Fawzia Butt ◽  
BedaOlabu Otieno ◽  
JuliusAlexander Ogeng'o
Keyword(s):  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Sternocleidomastoid Muscle ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Mastoid Process ◽  
Spinal Accessory ◽  
Posterior Triangle ◽  
Point Of Entry ◽  
The Right

The spinal accessory nerve (SAN) exhibits variant anatomy in its relation to the internal jugular vein (IJV) as well as the sternocleidomastoid muscle (SCM). These variations are important in locating the nerve during surgical neck procedures to avoid its inadvertent injury. These variations, however, are not conserved among different populations and data from the Kenyan setting are partly elucidated. This study, therefore, aims to determine the variant anatomical relationship of the SAN to the SCM and IJV in a select Kenyan population. Forty cadaveric necks were studied bilaterally during routine dissection and the data collected were analyzed using SPSS version 21. Means and modes were calculated for the point of entry of the SAN into the posterior triangle of the neck as well as for its relation to the SCM. Side variations for both of these were analyzed using Student's t-test. Data relating the SAN to the IJV were represented in percentages and side variations were analyzed using the chi-square test. The SAN point of entry into the posterior triangle of the neck was 5.38 cm (3.501–8.008 cm) on the left side and 5.637 cm (3.504–9.173 cm) on the right side ( p = 0.785) from the mastoid process. The nerve perforated the SCM in four cases (10%) on the left side and in eight cases (20%) on the right ( p = 0.253). The SAN lay predominantly medial to the IJV on both sides of the neck, 87.5% on the left side of the neck versus 82.5% on the right ( p = 0.831). In conclusion, the variant relation of the SAN to the IJV and SCM as observed in this setting is an important consideration during radical neck procedures and node biopsies.

scholarly journals Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion

2015 ◽  
Vol 6 (01) ◽  
pp. 112-115 ◽  
Author(s):  
Shyam Sundar Krishnan ◽  
Sivaram Bojja ◽  
Madabhushi Chakravarthy Vasudevan
Keyword(s):  
Cranial Nerves ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Cervical Canal ◽  
Review Of Literature ◽  
Diagnostic Dilemma ◽  
Spinal Accessory ◽  
Facial Nerves ◽  
Upper Cervical ◽  
The Ideal

ABSTRACTSchwannomas are benign lesions that arise from the nerve sheath of cranial nerves. The most common schwannomas arise from the 8 th cranial nerve (the vestibulo-cochlear nerve) followed by trigeminal and facial nerves and then from glossopharyngeal, vagus, and spinal accessory nerves. Schwannomas involving the oculomotor, trochlear, abducens and hypoglossal nerves are very rare. We report a very unusual spinal accessory nerve schwannoma which occupied the fourth ventricle and extended inferiorly to the upper cervical canal. The radiological features have been detailed. The diagnostic dilemma was due to its midline posterior location mimicking a fourth ventricular lesion like medulloblastoma and ependymoma. Total excision is the ideal treatment for these tumors. A brief review of literature with tabulations of the variants has been listed.

scholarly journals Surgical Anatomy of the Spinal Accessory Nerve in the Posterior Triangle of the Neck

2005 ◽  
Vol 28 (3) ◽  
pp. 171-173 ◽  
Author(s):  
Atchara Aramrattana ◽  
Kanchana Harnsiriwattanagit ◽  
Pichit Sittitrai
Keyword(s):  
Surgical Anatomy ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Posterior Triangle
Sign in / Sign up

Export Citation Format

Share Document