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Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping.

Lanisnik B, Zargi M, Rodi Z - Radiol Oncol (2014)

Bottom Line: In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%).The nerve than exits this junction more medially as a single trapezius branch.The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Slovenia.

ABSTRACT

Background: In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND).

Methods: The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor.

Results: The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch.

Conclusions: The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

No MeSH data available.


Related in: MedlinePlus

The recording of the compound action potential (CMAP) during mapping can be seen on the left side in a patient with type 3 branching. Channel 1 records superficial electrodes while Chanel 2 records from the subcutaneous electrodes. Channel 3 records the CMAP of the deltoid muscle. The left image represent the stimulation of the accessory nerve branches, while the right represents recording while stimulating the cervical branches of C4 where only stimulus artifact and not the CMAP is recorded. Similar results were obtained if we stimulated the C2 communicating branch.
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f5-rado-48-04-387: The recording of the compound action potential (CMAP) during mapping can be seen on the left side in a patient with type 3 branching. Channel 1 records superficial electrodes while Chanel 2 records from the subcutaneous electrodes. Channel 3 records the CMAP of the deltoid muscle. The left image represent the stimulation of the accessory nerve branches, while the right represents recording while stimulating the cervical branches of C4 where only stimulus artifact and not the CMAP is recorded. Similar results were obtained if we stimulated the C2 communicating branch.

Mentions: We couldn’t identify the motor response in the trapezius muscle when we stimulated different parts of the cervical roots C2, C3 or C4. If higher currents were used, we could identify the electrical stimulus artifacts on the superficial electrodes when stimulating cervical roots or different tissues of the neck (Figure 5). We identified C2 communication branch in all 74 dissections, but its thickness varied considerably. This branch always led to the trapezius branch and proved to be a reliable marker during the dissection.


Identification of three anatomical patterns of the spinal accessory nerve in the neck by neurophysiological mapping.

Lanisnik B, Zargi M, Rodi Z - Radiol Oncol (2014)

The recording of the compound action potential (CMAP) during mapping can be seen on the left side in a patient with type 3 branching. Channel 1 records superficial electrodes while Chanel 2 records from the subcutaneous electrodes. Channel 3 records the CMAP of the deltoid muscle. The left image represent the stimulation of the accessory nerve branches, while the right represents recording while stimulating the cervical branches of C4 where only stimulus artifact and not the CMAP is recorded. Similar results were obtained if we stimulated the C2 communicating branch.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230559&req=5

f5-rado-48-04-387: The recording of the compound action potential (CMAP) during mapping can be seen on the left side in a patient with type 3 branching. Channel 1 records superficial electrodes while Chanel 2 records from the subcutaneous electrodes. Channel 3 records the CMAP of the deltoid muscle. The left image represent the stimulation of the accessory nerve branches, while the right represents recording while stimulating the cervical branches of C4 where only stimulus artifact and not the CMAP is recorded. Similar results were obtained if we stimulated the C2 communicating branch.
Mentions: We couldn’t identify the motor response in the trapezius muscle when we stimulated different parts of the cervical roots C2, C3 or C4. If higher currents were used, we could identify the electrical stimulus artifacts on the superficial electrodes when stimulating cervical roots or different tissues of the neck (Figure 5). We identified C2 communication branch in all 74 dissections, but its thickness varied considerably. This branch always led to the trapezius branch and proved to be a reliable marker during the dissection.

Bottom Line: In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%).The nerve than exits this junction more medially as a single trapezius branch.The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology, Cervical and Maxillofacial Surgery, University Medical Center Maribor, Slovenia.

ABSTRACT

Background: In spite of preservation of the accessory nerve there is still considerable proportion of patients with partial nerve damage during modified radical neck dissection (MRND).

Methods: The nerve was identified during the surgery and its branches for the trapezius muscle mapped with nerve monitor.

Results: The accessory nerve was mapped during 74 hemineck dissections and three patterns were identified. In type 1 nerve exits at the posterior end of the sternocleidomastoid muscle (SCm) and then it enters the level V (66%). In type 2 the nerve for trapezius muscle branches off before entering the SCm (22%). In type 3 the nerve exits at the posterior part of the SCm and it joins to the cervical plexus (12%). The nerve than exits this junction more medially as a single trapezius branch.

Conclusions: The description of three anatomical patterns in level II and V could help preserving the trapezius branch during MRND.

No MeSH data available.


Related in: MedlinePlus