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Chabot AB, Iwanaga J, Dumont AS, Tubbs RS. A Rare Anatomical Variation of the Lesser Occipital Nerve. Cureus 2021; 13:e15901. [PMID: 34336417 PMCID: PMC8312764 DOI: 10.7759/cureus.15901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/08/2022] Open
Abstract
The lesser occipital nerve (LON) is a cutaneous branch of the cervical plexus that arises from the second and sometimes the third spinal nerve and innervates the scalp. During routine dissection of the neck, the LON was observed to arise directly from the spinal accessory nerve. The aberrant nerve measured 1.9 mm in diameter and 10.2 cm in length. Although anatomical variations of the LON such as duplication and triplication have been observed, we believe the origination of this nerve directly and exclusively from the spinal accessory nerve is exceedingly rare. The current case adds to the sparse literature on the variations of the LON and might be of interest to clinicians treating neurological conditions or surgeons operating in the area.
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Affiliation(s)
- A Bert Chabot
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Anatomical Sciences, St. George's University, St. George's, GRD.,Department of Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA.,Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, USA
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2
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Kim JS, Ko JS, Bang S, Kim H, Lee SY. Cervical plexus block. Korean J Anesthesiol 2018; 71:274-288. [PMID: 29969890 PMCID: PMC6078883 DOI: 10.4097/kja.d.18.00143] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/24/2018] [Indexed: 12/14/2022] Open
Abstract
Cervical plexus blocks (CPBs) have been used in various head and neck surgeries to provide adequate anesthesia and/or analgesia; however, the block is performed in a narrow space in the region of the neck that contains many sensitive structures, multiple fascial layers, and complicated innervation. Since the intermediate CPB was introduced in addition to superficial and deep CPBs in 2004, there has been some confusion regarding the nomenclature and definition of CPBs, particularly the intermediate CPB. Additionally, as the role of ultrasound in the head and neck region has expanded, CPBs can be performed more safely and accurately under ultrasound guidance. In this review, the authors will describe the methods, including ultrasound-guided techniques, and clinical applications of conventional deep and superficial CPBs; in addition, the authors will discuss the controversial issues regarding intermediate CPBs, including nomenclature and associated potential adverse effects that may often be neglected, focusing on the anatomy of the cervical fascial layers and cervical plexus. Finally, the authors will attempt to refine the classification of CPB methods based on the target compartments, which can be easily identified under ultrasound guidance, with consideration of the effects of each method of CPB.
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Affiliation(s)
- Jin-Soo Kim
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Justin Sangwook Ko
- Depatment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University College of Medicine,, Seoul, Korea
| | - Seunguk Bang
- Depatment of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyungtae Kim
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Johal J, Iwanaga J, Tubbs K, Loukas M, Oskouian RJ, Tubbs RS. The Accessory Nerve: A Comprehensive Review of its Anatomy, Development, Variations, Landmarks and Clinical Considerations. Anat Rec (Hoboken) 2018; 302:620-629. [DOI: 10.1002/ar.23823] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/11/2017] [Accepted: 05/14/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Jaspreet Johal
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
- Seattle Science FoundationSeattle Washington
| | - Joe Iwanaga
- Seattle Science FoundationSeattle Washington
| | - Kevin Tubbs
- Seattle Science FoundationSeattle Washington
| | - Marios Loukas
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
| | | | - R. Shane Tubbs
- Department of Anatomical SciencesSt. George's UniversitySt. George's Grenada
- Seattle Science FoundationSeattle Washington
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McGuinness BJ, Morrison JP, Brew SK, Moriarty MW. Benign Enhancing Foramen Magnum Lesions: Clinical Report of a Newly Recognized Entity. AJNR Am J Neuroradiol 2017; 38:721-725. [PMID: 28154124 DOI: 10.3174/ajnr.a5085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/03/2016] [Indexed: 11/07/2022]
Abstract
Intradural extramedullary foramen magnum enhancing lesions may be due to meningioma, nerve sheath tumor, aneurysm, or meningeal disease. In this clinical report of 14 patients, we describe a novel imaging finding within the foramen magnum that simulates disease. The lesion is hyperintense on 3D-FLAIR and enhances on 3D gradient-echo sequences but is not seen on 2D-TSE T2WI. It occurs at a characteristic location related to the posterior aspect of the intradural vertebral artery just distal to the dural penetration. Stability of this lesion was demonstrated in those patients who underwent follow-up imaging. Recognition of this apparently benign lesion may prevent unnecessary patient anxiety and repeat imaging.
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Affiliation(s)
- B J McGuinness
- From Trinity MRI (B.J.M., J.P.M., S.K.B., M.W.M.), Auckland, New Zealand .,Neuroradiology Section (B.J.M., S.K.B., M.W.M.), Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - J P Morrison
- From Trinity MRI (B.J.M., J.P.M., S.K.B., M.W.M.), Auckland, New Zealand
| | - S K Brew
- From Trinity MRI (B.J.M., J.P.M., S.K.B., M.W.M.), Auckland, New Zealand.,Neuroradiology Section (B.J.M., S.K.B., M.W.M.), Department of Radiology, Auckland City Hospital, Auckland, New Zealand
| | - M W Moriarty
- From Trinity MRI (B.J.M., J.P.M., S.K.B., M.W.M.), Auckland, New Zealand.,Neuroradiology Section (B.J.M., S.K.B., M.W.M.), Department of Radiology, Auckland City Hospital, Auckland, New Zealand
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Surgical anatomy of the spinal accessory nerve: review of the literature and case report of a rare anatomical variant. The Journal of Laryngology & Otology 2016; 130:969-972. [PMID: 27268496 DOI: 10.1017/s0022215116008148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the prevalence of variations in the anatomical route of the spinal accessory nerve from the base of the skull to the point where it enters the trapezius muscle. A case report is used to demonstrate an example of a rare but clinically important anatomical variant of this nerve. METHODS An independent review of the literature using Medline, PubMed and Q Read databases was performed using combinations of terms including 'spinal accessory nerve', 'anatomy', 'surgical anatomy', 'anatomical variant', 'cranial nerve XI' and 'shoulder syndrome'. RESULTS Our report demonstrates marked variation in spinal accessory nerve anatomy. At the point of crossing over the internal jugular vein, the spinal accessory nerve passes most commonly laterally (anterior) to the internal jugular vein. The reported incidence of this lateral relationship varies from 67 to 96 per cent. The nerve can also pierce the internal jugular vein, as demonstrated in our case study, with incidence ranging from 0.48 to 3.3 per cent. CONCLUSION Anatomical variations of the spinal accessory nerve are not uncommon, and it is important for the surgeon to be aware of such variations when undertaking surgery in both the anterior and posterior triangles of the neck.
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Tubbs RS, Ajayi OO, Fries FN, Spinner RJ, Oskouian RJ. Variations of the accessory nerve: anatomical study including previously undocumented findings-expanding our misunderstanding of this nerve. Br J Neurosurg 2016; 31:113-115. [PMID: 27216244 DOI: 10.1080/02688697.2016.1187253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The anatomy of the accessory nerve has been well described but continued new clinical and anatomical findings exemplify our lack of a full understanding of the course of this nerve. Therefore, this study aimed to expand on our knowledge of the course of the 11th cranial nerve via anatomical dissections. METHODS Fifty-six cadavers (112 sides) underwent dissection of the accessory nerve from its cranial and spinal origins to its emergence into the posterior cervical triangle. Immunohistochemistry was performed when appropriate. RESULTS Our findings included two cases (1.8%) where the nerve was duplicated, one intracranially and one extracranially. One accessory nerve (0.9%) was found to enter its own dural compartment within the jugular foramen. The majority of sides (80%) were found to have a cranial root of the accessory nerve. Thirty-one sides (28%) had connections to cervical dorsal roots medially and three sides (2.7%) laterally. Medial connections were most common with the C1 nerve. Medial components of these dorsal root connections were all sensory in nature. However, lateral components were motor on two sides (1.8%). Nerves traveled anterior to the internal jugular vein on 88% of sides. One (0.9%) left side nerve joined an interneural anastomosis between the dorsal rootlets. Macroganglia were found on the spinal part of the intracranial nerve on 13% of sides. The lesser occipital nerve arose directly from the accessory nerve on two sides (1.8%) and communicated with the accessory nerve on 5.4% of sides. One side (0.9%) was found to communicate with the facial nerve with both nerves innervating the sternocleidomastoid muscle. CONCLUSIONS Additional anatomical knowledge of the variants of the accessory nerve may benefit patient care when this nerve is pathologically involved.
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Affiliation(s)
- R Shane Tubbs
- a Department of Neurosurgery , Seattle Science Foundation , Seattle , WA , USA.,b Department of Anatomical Sciences , St. George's University , True Blue , Grenada
| | - Olaide O Ajayi
- c Department of Neurosurgery , Swedish Neuroscience Institute , Seattle , WA , USA.,d Department of Neurosurgery , Loma Linda University , Loma Linda , CA , USA
| | - Fabian N Fries
- e Saarland University Medical Center, Faculty of Medicine, Saarland University , Homburg , Germany
| | - Robert J Spinner
- f Department of Neurosurgery , Mayo Clinic , Rochester , MN , USA
| | - Rod J Oskouian
- d Department of Neurosurgery , Loma Linda University , Loma Linda , CA , USA
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Boehm KE, Kondrashov P. Distribution of Neuron Cell Bodies in the Intraspinal Portion of the Spinal Accessory Nerve in Humans. Anat Rec (Hoboken) 2015; 299:98-102. [PMID: 26474532 DOI: 10.1002/ar.23279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/15/2015] [Accepted: 07/28/2015] [Indexed: 12/18/2022]
Affiliation(s)
- Karl E. Boehm
- Department of Anatomy, Kirksville College of Osteopathic Medicine; A.T. Still University; 800 West Jefferson Street Kirksville Missouri 63501
| | - Peter Kondrashov
- Department of Anatomy, Kirksville College of Osteopathic Medicine; A.T. Still University; 800 West Jefferson Street Kirksville Missouri 63501
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