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Roberts SO, Cardozo A. A detailed review of the spinal accessory nerve and its anatomical variations with cadaveric illustration. Anat Sci Int 2024; 99:239-253. [PMID: 38696101 PMCID: PMC11143051 DOI: 10.1007/s12565-024-00770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/04/2024] [Indexed: 06/01/2024]
Abstract
The spinal accessory nerve, considered part of the eleventh cranial nerve, provides motor innervation to sternocleidomastoid and trapezius. A comprehensive literature review and two cadaveric dissections were undertaken. The spinal accessory nerve originates from the spinal accessory nucleus. Its rootlets unite and ascend between the denticulate ligament and dorsal spinal rootlets. Thereafter, it can anastomose with spinal roots, such as the McKenzie branch, and/or cranial roots. The spinal accessory nerve courses intracranially via foramen magnum and exits via jugular foramen, within which it usually lies anteriorly. Extracranially, it usually crosses anterior to the internal jugular vein and lies lateral to internal jugular vein deep to posterior belly of digastric. The spinal accessory nerve innervates sternocleidomastoid, receives numerous contributions in the posterior triangle and terminates within trapezius. Its posterior triangle course approximates a perpendicular bisection of the mastoid-mandibular angle line. The spinal accessory nerve contains sensory nociceptive fibres. Its cranial nerve classification is debated due to occasional non-fusion with the cranial root. Surgeons should familiarize themselves with the variable course of the spinal accessory nerve to minimize risk of injury. Patients with spinal accessory nerve injuries might require specialist pain management.
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Affiliation(s)
- Siôn Owain Roberts
- Department of Anatomy, Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, Yorkshire, LS2 9JT, UK.
| | - Arun Cardozo
- Department of Otorhinolaryngology, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire, PR2 9HT, UK
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Ren X, Li M, Zhao X, Liu Z, Ren S, Zhang Y, Zhang S, Canavero S. First cephalosomatic anastomosis in a human model. Surg Neurol Int 2017; 8:276. [PMID: 29279793 PMCID: PMC5705925 DOI: 10.4103/sni.sni_415_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background: Cephalosomatic anastomosis (CSA) has never been attempted before in man as the transected spinal cords of the body donor and body recipient could not be “fused” back together. Recent advances made this possible. Here, we report on the surgical steps necessary to reconnect a head to a body at the cervical level. Methods: Full rehearsal of a CSA on two recently deceased human cadavers was performed at Harbin Medical University, Harbin, China. Results: The surgery took 18 hours to complete within the time frame planned for this surgery. Several advances resulted from this rehearsal, including optimization of the surgical steps, sparing of the main nerves (phrenics, recurrent laryngeal nerves), and assessment of vertebral stabilization. Conclusion: Several specialties are involved in a full-scale CSA, including neck surgery, vascular surgery, orthopedic surgery, plastic surgery, gastrointestinal surgery, and neurosurgery, as well as the operating staff. This rehearsal confirmed the surgical feasibility of a human CSA and further validated the surgical plan. Education and coordination of all the operating teams and coordination of the operative staff was achieved in preparation for the live human CSA.
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Affiliation(s)
- Xiaoping Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China.,Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University, Chicago, Illinois, USA
| | - Ming Li
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Xin Zhao
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Zehan Liu
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Shuai Ren
- Hand and Microsurgical Center, 2 Affiliated Hospital, Harbin Medical University, Harbin, China.,State-Province Key Laboratories of Biomedicine-Pharmaceutics, Harbin Medical University, Harbin, China.,Heilongjiang Medical Science Institute, Harbin Medical University, Harbin, China
| | - Yafang Zhang
- Department of Anatomy, Harbin Medical University, Harbin, China
| | - Shide Zhang
- Department of Radiology, 2 Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Sergio Canavero
- Turin Advanced Neuromodulation Group, Turin, Italy, Harbin Medical University, Harbin, China
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Abstract
Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.
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Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
| | - Wolfgang Grisold
- Department of Neurology, Kaiser-Franz-Josef Spital, Vienna, Austria, Europe
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Intradural communication between dorsal rootlets of spinal nerves: their clinical significance. Acta Neurochir (Wien) 2015; 157:1069-76; discussion 1076. [PMID: 25911298 DOI: 10.1007/s00701-015-2425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anatomical and surgical textbooks give almost no attention to the intradural communications between dorsal rootlets of adjacent spinal nerves. These communications can be of significance in various neurosurgical procedures and clinical conditions of the region. METHODS The spinal cord of six formaldehyde-fixed cadavers was dissected from C1-S5. The dorsal rootlets of the spinal nerves were exposed via a posterior approach and communications between adjacent spinal nerves were documented. RESULTS The frequency of communication between adjacent dorsal rootlets of the spinal nerves showed variations among spinal levels. Thirty-eight dorsal rootlet communications were observed in six cadavers (12 sides) and 20 (52.6%) were at cervical levels, 14 (36.8%) at thoracic levels, and four (10.5%) at lumbar levels. The majority of communications were observed on the left side (65.8%). Communications were most frequently observed at cervical (C4-C5, C5-C6) and upper thoracic (T1-T2) levels and seen least frequently at lower thoracic and lumbar levels. No communications were observed at sacral levels. Five types of communication were observed: I. oblique ascending, II. oblique descending III. short Y, IV. long Y and V shaped. None of the communication extended beyond one segment at any spinal level. The occurrence of such dorsal rootlet communications ranged from 3 to 7 for each cadaver and the mean was 4.8 ± 1.3. Histological sections from various levels of the dorsal rootlet communications showed that all consisted of myelinated fibers of varying diameters. CONCLUSIONS Such communications may lead to misinterpretation of the pathology on the basis of clinical signs and symptoms and also should be considered in rhizotomy.
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Oh CS, Chung IH, Lee KS. Topographical anatomy on the communicating branch between the spinal accessory nerve and the anterior root of the first cervical nerve. Surg Radiol Anat 2003; 25:207-9. [PMID: 12748814 DOI: 10.1007/s00276-003-0108-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2002] [Accepted: 12/25/2002] [Indexed: 10/26/2022]
Abstract
The aim of this study was to clarify the morphological characteristics of the communicating branch between the spinal accessory nerve and the anterior root of the first cervical nerve (McKenzie branch), a structure severed during intradural selective rhizotomy for treatment of spasmodic torticollis. The right and left sides of 50 upper cervical segments of spinal cords were dissected and examined under a surgical microscope. Seven of the total 100 samples were found to have the McKenzie branch. Two types of McKenzie branch, which run close to the vertebral artery, were also identified, which might be helpful for improving the surgical results of intradural selective rhizotomy.
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Affiliation(s)
- C S Oh
- Department of Anatomy, Sungkyunkwan University School of Medicine, 440-746 Suwon, Korea.
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