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

R. Shane Tubbs, William Stetler, Robert G. Louis, Ankmalika A. Gupta, Marios Loukas, David R. Kelly, Mohammadali Mohajel Shoja, Aaron A. Cohen-Gadol

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)22-24
Number of pages3
JournalJournal of Neurosurgery: Spine
Volume12
Issue number1
DOIs
StatePublished - Jan 1 2010
Externally publishedYes

Fingerprint

Accessory Nerve
Hypoglossal Nerve
Vagus Nerve
Cranial Nerves
Neck
Nerve Transfer
Neck Dissection
Wounds and Injuries
Peripheral Nerves
Cadaver
Anatomy
Histology
Electron Microscopy
Fetus
Pregnancy

Keywords

  • Cranial nerve anatomy
  • Morphology
  • Neck dissection
  • Spinal accessory nerve
  • Traction injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Surgical challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle : Functional or structural? Laboratory investigation. / Tubbs, R. Shane; Stetler, William; Louis, Robert G.; Gupta, Ankmalika A.; Loukas, Marios; Kelly, David R.; Mohajel Shoja, Mohammadali; Cohen-Gadol, Aaron A.

In: Journal of Neurosurgery: Spine, Vol. 12, No. 1, 01.01.2010, p. 22-24.

Research output: Contribution to journalArticle

Tubbs, R. Shane ; Stetler, William ; Louis, Robert G. ; Gupta, Ankmalika A. ; Loukas, Marios ; Kelly, David R. ; Mohajel Shoja, Mohammadali ; Cohen-Gadol, Aaron A. / Surgical challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle : Functional or structural? Laboratory investigation. In: Journal of Neurosurgery: Spine. 2010 ; Vol. 12, No. 1. pp. 22-24.
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abstract = "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.",
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T1 - Surgical challenges associated with the morphology of the spinal accessory nerve in the posterior cervical triangle

T2 - Functional or structural? Laboratory investigation

AU - Tubbs, R. Shane

AU - Stetler, William

AU - Louis, Robert G.

AU - Gupta, Ankmalika A.

AU - Loukas, Marios

AU - Kelly, David R.

AU - Mohajel Shoja, Mohammadali

AU - Cohen-Gadol, Aaron A.

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N2 - 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.

AB - 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.

KW - Cranial nerve anatomy

KW - Morphology

KW - Neck dissection

KW - Spinal accessory nerve

KW - Traction injury

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