The “vagal ansa”: a source of complication in vagus nerve stimulation

A 16-year-old boy underwent vagus nerve stimulation for treatment-resistant multifocal epilepsy. During intraoperative system diagnostics, vigorous contraction of the ipsilateral sternomastoid muscle was observed. On re-exploration, a thin nerve fiber passing from the vagus to the sternomastoid was found hooked up in the upper electrode. Detailed inspection revealed an abnormal course of the superior root of the ansa cervicalis, which descended down as a single nerve trunk with the vagus and separated to join the inferior root. The authors discuss the variation in the course of the ansa cervicalis and how this could be a reason for postoperative neck muscle contractions.

A Simple Technique to Prevent External Jugular Vein Compression after Microanastomosis

External jugular vein (EJV) is one of the most commonly used veins for microanastomosis in head and reconstruction. Being in the subcutaneous plane, the EJV is prone for compression from both external and internal factors after mobilization for anastomosis. To prevent this, we describe a technique where a trench is created in the sternomastoid muscle in which the EJV is placed safely and prevented from compression.