Superficial landmarks for the spinal accessory nerve within the posterior cervical triangle

2005 ◽  
Vol 3 (5) ◽  
pp. 375-378 ◽  
Author(s):  
R. Shane Tubbs ◽  
E. George Salter ◽  
John C. Wellons ◽  
Jeffrey P. Blount ◽  
W. Jerry Oakes
Keyword(s):  
The Body ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Mastoid Process ◽  
Exit Point ◽  
Content Type ◽  
Spinal Accessory ◽  
Mean Width ◽  
The Mean ◽  
Fine Print

Object. The spinal accessory nerve (SAN) within the posterior cervical triangle (PCT) is the most commonly iatrogenically injured nerve in the body. Nevertheless, there is a paucity of published information regarding superficial landmarks for the SAN in this region. Additional identifiable landmarks of this nerve may assist the surgeon in identifying it for repair, use of it in peripheral nerve neurotization, or avoiding it as in proximal brachial plexus repair. The present study was undertaken to provide reliable superficial landmarks for the identification of the SAN within the PCT. Methods. The PCT was dissected in 30 cadaveric sides. Measurements were made between the SAN and surrounding landmarks. The mean distances between the entry site of the SAN into the trapezius and a midpoint of the clavicle, mastoid process, acromion process, and lateral aspect of the sternocleidomastoid (SCM) muscle were 6, 7, 5.5, and 3.5 cm, respectively. The mean distances between the angle of the mandible and the mastoid process and the exit point of the SAN from the posterior border of the SCM muscle were 6 and 5 cm, respectively. The mean width and length of the SAN were 3 and 3.5 cm, respectively. Conclusions. It is the authors' hope that these data will aid those who may need to locate or avoid the SAN while undertaking surgery in the PCT and thus decrease morbidity that may follow manipulation of this region.

Stretch palsy of the spinal accessory nerve

1990 ◽  
Vol 72 (3) ◽  
pp. 500-502 ◽  
Author(s):  
A. Lee Dellon ◽  
James N. Campbell ◽  
David Cornblath
Keyword(s):  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Blunt Injury ◽  
Nerve Grafting ◽  
Content Type ◽  
Spinal Accessory ◽  
Fine Print

✓ Although sharp and blunt injury to the spinal accessory nerve has been well-documented, stretch or traction-type injury has not been reported previously. Such a case, treated successfully with nerve grafting, is described.

Spasmodic torticollis due to neurovascular compression of the 11th nerve

1985 ◽  
Vol 63 (5) ◽  
pp. 789-791 ◽  
Author(s):  
Carlo A. Pagni ◽  
Michele Naddeo ◽  
Giuliano Faccani
Keyword(s):  
Unusual Case ◽  
Spasmodic Torticollis ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Neurovascular Compression ◽  
Content Type ◽  
Spinal Accessory ◽  
Cerebellar Artery ◽  
Fine Print

✓ An unusual case of spasmodic torticollis caused by posteroinferior cerebellar artery compression of the spinal accessory nerve is reported. The spasmodic torticollis was cured by abolishing the neurovascular compression.

Long-term results of spinal accessory nerve-facial nerve anastomosis

1992 ◽  
Vol 77 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Michael J. Ebersold ◽  
Lynn M. Quast
Keyword(s):  
Facial Nerve ◽  
Functional Disability ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Long Term Results ◽  
Content Type ◽  
Spinal Accessory ◽  
Nerve Anastomosis ◽  
Facial Function ◽  
Fine Print

✓ A number of methods have been developed to reduce the cosmetic and functional disability resulting from facial nerve loss. It has often been suggested that the major trunk of the spinal accessory nerve should not be sacrificed for providing dynamic facial function because of shoulder disability and pain. A review of Mayo Clinic records has revealed that, between the years of 1975 and 1983, 25 patients underwent spinal accessory nerve-facial nerve anastomosis using the major division (branch to the trapezius muscle) of the spinal accessory nerve. There were 11 males and 14 females, ranging in age from 16 to 60 years (mean 41 years). The interval between facial nerve loss and anastomosis was 1 week to 34 months (mean 4.62 months). The duration of follow-up study ranged from 7 to 15 years (mean 10.8 years). Twenty patients had no complaints or symptoms related to their shoulder or arm at the time of this review and no patient had significant shoulder morbidity. The facial function achieved was “minimal” in five cases, “moderate” in six, and good to excellent in 14. Most patients appeared to benefit significantly from the spinal accessory nerve-facial nerve anastomosis. The morbidity of the procedure seemed quite minimal even in the young and active. The authors continue to believe that the spinal accessory nerve-facial nerve anastomosis, even when using the major trunk of the spinal accessory nerve, is a very useful and beneficial procedure.

Far-field responses to stimulation of the cochlear nucleus by microsurgically placed penetrating and surface electrodes in the cat

2001 ◽  
Vol 95 (5) ◽  
pp. 845-852 ◽  
Author(s):  
Steffen K. Rosahl ◽  
Gerhard Mark ◽  
Martin Herzog ◽  
Christos Pantazis ◽  
Farnaz Gharabaghi ◽  
...  
Keyword(s):  
Cochlear Nucleus ◽  
Auditory Brainstem ◽  
Mastoid Process ◽  
Electrode Arrays ◽  
Content Type ◽  
Surface Electrodes ◽  
Brainstem Response ◽  
The Mean ◽  
Fine Print ◽  
Stimulation Of

Object. A new generation of penetrating electrodes for auditory brainstem implants is on the verge of being introduced into clinical practice. This study was designed to compare electrically evoked auditory brainstem responses (EABRs) to stimulation of the cochlear nucleus (CN) by microsurgically implanted surface electrodes and insertion electrodes (INSELs) with stimulation areas of identical size. Methods. Via a lateral suboccipital approach, arrays of surface and penetrating microelectrodes with geometric stimulation areas measuring 4417 µm2 (diameter 75 µm) were placed over and inserted into the CN in 10 adult cats. After recording the auditory brainstem response (ABR) at the mastoid process, the CN, and the level of the inferior colliculus, EABRs to stimulation of the CN were recorded using biphasic, charge-balanced stimuli with phase durations of 80 µsec, 160 µsec, and 240 µsec at a repetition rate of 22.3 Hz. Waveform, threshold, maximum amplitude, and the dynamic range of the responses were compared for surface and penetrating electrodes. The EABR waveforms that appeared for both types of stimulation resembled each other closely. The mean impedance was slightly lower (30 ± 3.4 kΩ compared with 31.7 ± 4.5 kΩ, at 10 kHz), but the mean EABR threshold was significantly higher (51.8 µA compared with 40.5 µA, t = 3.5, p = 0.002) for surface electrode arrays as opposed to penetrating electrode arrays. Due to lower saturation levels of the INSEL array, dynamic ranges were almost identical between the two types of stimulation. Sectioning of the eighth cranial nerve did not abolish EABRs. Conclusions. Microsurgical insertion of electrodes into the CN complex may be guided and monitored using techniques similar to those applied for implantation of surface electrodes. Lower thresholds and almost equivalent dynamic ranges indicate that a more direct access to secondary auditory neurons is achieved using penetrating electrodes.

Surgical anatomy of the axillary nerve within the quadrangular space

2005 ◽  
Vol 102 (5) ◽  
pp. 912-914 ◽  
Author(s):  
R. Shane Tubbs ◽  
Elizabeth C. Tyler-Kabara ◽  
Alan C. Aikens ◽  
Justin P. Martin ◽  
Leslie L. Weed ◽  
...  
Keyword(s):  
Axillary Nerve ◽  
Surgical Anatomy ◽  
Triceps Brachii ◽  
Main Trunk ◽  
Content Type ◽  
Mean Width ◽  
Human Cadavers ◽  
The Mean ◽  
Nerve Muscle ◽  
Fine Print

Object. There is a paucity of literature regarding the surgical anatomy of the quadrangular space (QS), which is a potential site of entrapment for the axillary nerve. Muscle hypertrophy of this geometrical area and fascial bands within it have been implicated in compression of the axillary nerve. Methods. Fifteen human cadavers (30 sides) were dissected for this study. Measurements of the QS and its contents were made. The mean height of this space was 2.5 cm and the mean width 2.5 cm; its mean depth was 1.5 cm. The axillary nerve was always the most superior structure in the space, and in all cases the nerve and artery hugged the surgical neck of the humerus just superior to the origin of the lateral head of the triceps brachii muscle. This arrangement placed the axillary nerve in the upper lateral portion of the QS in all cadaveric specimens. The nerve branched into its muscular components within this space in 10 sides (33%) and posterior to it in 20 sides (66%). The cutaneous component of the axillary nerve branched from the main trunk of the nerve posterior to the QS in all specimens. Fascial bands were found in this space in 27 (90%) of 30 sides. Conclusions. Knowledge of the anatomy of the QS may aid the surgeon who wishes to explore and decompress the axillary nerve within this geometrical confine.

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.

Quantification of in vivo Photofrin uptake by human pituitary adenoma tissue

2004 ◽  
Vol 101 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Usiakimi Igbaseimokumo
Keyword(s):  
Photodynamic Therapy ◽  
Pituitary Adenoma ◽  
The Body ◽  
Human Pituitary ◽  
Human Pituitary Adenoma ◽  
Content Type ◽  
The Mean ◽  
Adenoma Tissue ◽  
Fine Print

Object. Photofrin is widely distributed in the body after intravenous injection. This study was designed to quantify the preferential uptake of Photofrin by pituitary adenoma tissue for intraoperative photodynamic therapy. Methods. Eight patients (seven men) with recurrent pituitary adenomas who had undergone previous surgery and radiation therapy were recruited for a Phase I/II feasibility study of the application of photodynamic therapy to pituitary tumors. Photofrin was administered intravenously at a dose of 2 mg/kg body weight 48 hours before repeated transsphenoidal hypophysectomy was performed. At the time of the operation, pituitary adenoma tissue, muscle, fat, skin, and plasma were obtained for measurement of Photofrin content by fluorometric assay. The mean Photofrin level in pituitary adenoma tissue was 6.87 ng/mg (95% confidence interval [CI] 3.99–9.75), which was significantly higher than the uptake by skeletal muscle (2.24 ng/mg, 95% CI 1.28–3.2; p = 0.008), or fat (2.54 ng/mg, 95% CI 0.66–4.42; p = 0.007). Nevertheless, the mean drug concentration in pituitary adenoma tissue was not significantly different from the level in plasma (7.65 µg/ml, 95% CI 5.38–9.90; p = 0.558). Skin specimens were available in four patients, and these showed a mean uptake of 2.19 ng/mg. Conclusions. Photofrin is preferentially retained by pituitary adenoma tissue to levels both adequate for intraoperative photodynamic therapy and approximately 50% higher than those reported for gliomas.

Anastomotic connections between the eleventh nerve and the posterior root of the first cervical nerve in humans

1973 ◽  
Vol 38 (2) ◽  
pp. 189-197 ◽  
Author(s):  
G. Ouaknine ◽  
H. Nathan
Keyword(s):  
Spinal Cord ◽  
Cranial Nerve ◽  
Spinal Accessory Nerve ◽  
Posterior Root ◽  
Cervical Nerve ◽  
Content Type ◽  
Spinal Accessory ◽  
Points Of View ◽  
Sensory Fibers ◽  
Fine Print

✓ A study of connections between C-1, C-2, and the spinal accessory nerve is reported. Four variations are described from anatomical and clinical points of view. Often the only pathway for the sensory fibers of C-1 to reach the spinal cord is through the rootlets of the eleventh cranial nerve.

scholarly journals Results of spinal accessory to suprascapular nerve transfer in 110 patients with complete palsy of the brachial plexus

2016 ◽  
Vol 24 (6) ◽  
pp. 990-995 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Spinal Accessory Nerve ◽  
Accessory Nerve ◽  
Spinal Accessory ◽  
Extended Approach ◽  
The Mean

OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002–2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study. Their average age was 26 years (SD 8.4 years), and the mean interval between their injury and surgery was 5.2 months (SD 2.4 months). Prior to 2005, the suprascapular and spinal accessory nerves were dissected through a classic supraclavicular L-shape incision (n = 29). Afterward (n = 81), the spinal accessory and suprascapular nerves were dissected via an oblique incision, extending from the point at which the plexus crossed the clavicle to the anterior border of the trapezius muscle. In 17 of these patients, because of clavicle fractures or dislocation, scapular fractures or retroclavicular scarring, the incision was extended by detaching the trapezius from the clavicle to expose the suprascapular nerve at the suprascapular fossa. In all patients, the brachial plexus was explored and elbow flexion reconstructed by root grafting (n = 95), root grafting and phrenic nerve transfer (n = 6), phrenic nerve transfer (n = 1), or third, fourth, and fifth intercostal nerve transfer. Postoperatively, patients were followed for an average of 40 months (SD 13.7 months). RESULTS Failed recovery, meaning less than 30° abduction, was observed in 10 (9%) of the 110 patients. The failure rate was 25% between 2002 and 2004, but dropped to 5% after the staged/extended approach was introduced. The mean overall range of abduction recovery was 58.5° (SD 26°). Comparing before and after distal suprascapular nerve exploration (2005–2012), the range of abduction recovery was 45° (SD 25.1°) versus 62° (SD 25.3°), respectively (p = 0.002). In patients who recovered at least 30° of abduction, recovery of elbow flexion to at least an M3 level of strength increased the range of abduction by an average of 13° (p = 0.01). Before the extended approach, 2 (7%) of 29 patients recovered active external rotation of 20° and 120°. With the staged/extended approach, 32 (40%) of 81 recovered some degree of active external rotation. In these patients, the average range of motion measured from the thorax was 87° (SD 40.6°). CONCLUSIONS In total palsies of the brachial plexus, using the spinal accessory nerve for transfer to the suprascapular nerve is reliable and provides some recovery of abduction for a large majority of patients. In a few patients, a more extensive approach to access the suprascapular nerve, including, if necessary, dissection in the suprascapular fossa, may enhance outcomes.

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