The Experts below are selected from a list of 306 Experts worldwide ranked by ideXlab platform
W. W. Williams - One of the best experts on this subject based on the ideXlab platform.
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sensory pathways in the spinal Accessory Nerve
Journal of Bone and Joint Surgery-british Volume, 1999Co-Authors: A T Bremnersmith, A J Unwin, W. W. WilliamsAbstract:We obtained samples of spinal Accessory Nerve from patients undergoing radical surgery for tumours or Nerve grafting in the neck. These were analysed by light and electron microscopy for the type of fibre. All contained fibres consistent with non-proprioceptive sensory function including pain.
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The posterior triangle and the painful shoulder: spinal Accessory Nerve injury.
Annals of The Royal College of Surgeons of England, 1996Co-Authors: W. W. Williams, R. S. Twyman, Simon T. Donell, R. BirchAbstract:Forty-three cases of Accessory Nerve injury referred to the Peripheral Nerve Injury Unit have been reviewed. Accessory Nerve injury results in a characteristic group of symptoms and signs. Referral for treatment is usually delayed, the average time being 11.3 months. Surgical treatment resulted in improvement of symptoms in almost all cases.
Louis U Bigliani - One of the best experts on this subject based on the ideXlab platform.
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spinal Accessory Nerve injury
Clinical Orthopaedics and Related Research, 1999Co-Authors: J M Wiater, Louis U BiglianiAbstract:Injury to the spinal Accessory Nerve can lead to dysfunction of the trapezius. The trapezius is a major scapular stabilizer and is composed of three functional components. It contributes to scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The superficial course of the spinal Accessory Nerve in the posterior cervical triangle makes it susceptible to injury. Iatrogenic injury to the Nerve after a surgical procedure is one of the most common causes of trapezius palsy. Dysfunction of the trapezius can be a painful and disabling condition. The shoulder droops as the scapula is translated laterally and rotated downward. Patients present with an asymmetric neckline, a drooping shoulder, winging of the scapula, and weakness of forward elevation. Evaluation should include a complete electrodiagnostic examination. If diagnosed within 1 year of the injury, microsurgical reconstruction of the Nerve should be considered. Conservative treatment of chronic trapezius paralysis is appropriate for older patients who are sendentary. Active and healthy patients in whom 1 year of conservative treatment has failed are candidates for surgical reconstruction. Studies have shown the Eden-Lange procedure, in which the insertions of the levator scapulae, rhomboideus minor, and rhomboideus major muscles are transferred, relieves pain, corrects deformity, and improves function in patients with irreparable injury to the spinal Accessory Nerve.
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Spinal Accessory Nerve injury.
Clinical Orthopaedics and Related Research, 1999Co-Authors: Louis U BiglianiAbstract:Injury to the spinal Accessory Nerve can lead to dysfunction of the trapezius. The trapezius is a major scapular stabilizer and is composed of three functional components. It contributes to scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The superficial course of the spina
Marcos Flávio Ghizoni - One of the best experts on this subject based on the ideXlab platform.
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Combined injury of the Accessory Nerve and brachial plexus.
Neurosurgery, 2011Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:BACKGROUND: Stretch-induced spinal Accessory Nerve palsy has been considered extremely rare, with only a few cases reported. OBJECTIVE: In 357 patients with stretch lesions of the brachial plexus, we investigated the prevalence, course, and surgical treatment of Accessory Nerve palsy. METHODS: Accessory Nerve palsy was ascertained when the patient was unable to shrug the ipsilateral shoulder. Patients underwent brachial plexus reconstruction between 6 and 8 months after trauma. To confirm paralysis, during surgery, the Accessory Nerve was stimulated electrically. RESULTS: Accessory Nerve palsy occurred in 19 of the 327 patients (6%) with upper type or complete palsy of the brachial plexus. Proximal injuries of the Accessory Nerve accompanied by voice alteration and complete palsy of the sternocleidomastoid and trapezius muscle occurred in 2 patients. Proximal palsy without vocal alterations was observed in 6 patients. Palsy of the trapezius muscle with preservation of the sternocleidomastoid muscle occurred in 11 patients. All 7 patients who demonstrated muscle contractions upon electrical stimulation of the Accessory Nerve during surgery recovered completely. Patients with surgical reconstruction of the Accessory Nerve through grafting (n = 2) or repair by platysma motor Nerve transfer (n = 2) recovered active shoulder shrugging within 36 months of surgery. Seven of the 8 patients without Accessory Nerve reconstruction recovered from their drop shoulder and head tilt, but remained unable to shrug. CONCLUSION: If intraoperative electrical stimulation produces contraction of the upper trapezius muscle, no repair is needed. In proximal injuries, the platysma motor branch should be transferred to the Accessory Nerve; whereas in paralysis distal to the sternocleidomastoid muscle, the Accessory Nerve should be explored and grafted.
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Refinements in the technique for repair of the Accessory Nerve.
Journal of Hand Surgery (European Volume), 2006Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:Trapezius muscle palsy after Accessory Nerve injury leads to periscapular pain and shoulder motion deficit. The results of Accessory Nerve repair generally are good, but surgery is difficult. The difficulty consists of finding the Nerve stumps that are embedded in fat and scar tissue from previous surgeries or injuries. Five patients with Accessory Nerve lesions had surgery and grafting of the Accessory Nerve. We dissected the proximal stump of the Accessory Nerve within the fibers of the sternocleidomastoid muscle and in the vicinity of the greater auricular Nerve. To achieve dissection of the distal Nerve stump, the deep cervical fascia was detached from the trapezius muscle 3 cm cephalad to the clavicle. The detached fascia and the trapezius muscle were flipped similar to book pages. The motor branches entering the trapezius muscle were visualized and followed toward the Accessory Nerve. A sural Nerve graft with a mean length of 6.6 cm was used for grafting. Uncomplicated identification of the Nerve stumps was possible in all patients. After Accessory Nerve grafting, pain and motion consistently improved in all patients. The technique proposed here ensures reliable and rapid identification of the divided stumps of the Accessory Nerve.
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Improved technique for harvesting the Accessory Nerve for transfer in brachial plexus injuries.
Neurosurgery, 2006Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:OBJECTIVE: The Accessory Nerve is frequently used as a donor for Nerve transfer in brachial plexus injuries. In currently available techniques, Nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the Nerve. We propose a technique for location and dissection of the Accessory Nerve between the deep cervical fascia and the trapezius muscle. METHODS: Twenty-eight patients with brachial plexus palsy had the Accessory Nerve surgically transplanted to the suprascapular Nerve. To harvest the Accessory Nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The Accessory Nerve and its branches entering the trapezius muscle were identified. The Accessory Nerve was sectioned as distally as possible. To allow for Accessory Nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the Accessory Nerve was passed through this tunnel to the brachial plexus. RESULTS: In all of the cases, the Accessory Nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the Accessory Nerve with the suprascapular Nerve was possible in all patients. CONCLUSION: The technique proposed here for harvesting the Accessory Nerve for transfer made its identification and dissection easier.
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TECHNIQUE Refinements in the Technique for Repair of the Accessory Nerve
2006Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:Trapezius muscle palsy after Accessory Nerve injury leads to periscapular pain and shoulder motion deficit. The results of Accessory Nerve repair generally are good, but surgery is difficult. The difficulty consists of finding the Nerve stumps that are embedded in fat and scar tissue from previous surgeries or injuries. Five patients with Accessory Nerve lesions had surgery and grafting of the Accessory Nerve. We dissected the proximal stump of the Accessory Nerve within the fibers of the sternocleidomastoid muscle and in the vicinity of the greater auricular Nerve. To achieve dissection of the distal Nerve stump, the deep cervical fascia was detached from the trapezius muscle 3 cm cephalad to the clavicle. The detached fascia and the trapezius muscle were flipped similar to book pages. The motor branches entering the trapezius muscle were visualized and followed toward the Accessory Nerve. A sural Nerve graft with a mean length of 6.6 cm was used for grafting. Uncomplicated identification of the Nerve stumps was possible in all patients. After Accessory Nerve grafting, pain and motion consistently improved in all patients. The technique proposed here ensures reliable and rapid identification of the divided stumps of the Accessory Nerve. (J Hand Surg 2006;31A: 1401‐1406. Copyright © 2006 by the American Society for Surgery of the Hand.)
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Improved technique for harvesting the Accessory Nerve for transfer in brachial plexus injuries.
Neurosurgery, 2006Co-Authors: Jayme Augusto Bertelli, Marcos Flávio GhizoniAbstract:The Accessory Nerve is frequently used as a donor for Nerve transfer in brachial plexus injuries. In currently available techniques, Nerve identification and dissection is difficult because fat tissue, lymphatic vessels, and blood vessels surround the Nerve. We propose a technique for location and dissection of the Accessory Nerve between the deep cervical fascia and the trapezius muscle. Twenty-eight patients with brachial plexus palsy had the Accessory Nerve surgically transplanted to the suprascapular Nerve. To harvest the Accessory Nerve, the anterior border of the trapezius muscle was located 2 to 3 cm above the clavicle. The fascia over the trapezius muscle was incised and detached from the anterior surface of the muscle, initially, close to the clavicle, then proximally. The trapezius muscle was detached from the clavicle for 3 to 4 cm. The Accessory Nerve and its branches entering the trapezius muscle were identified. The Accessory Nerve was sectioned as distally as possible. To allow for Accessory Nerve mobilization, one or two proximal branches to the trapezius muscle were cut. The most proximal branch was always identified and preserved. A tunnel was created in the detached fascia, and the Accessory Nerve was passed through this tunnel to the brachial plexus. In all of the cases, the Accessory Nerve was easily identified under direct vision, without the use of electric stimulation. Direct coaptation of the Accessory Nerve with the suprascapular Nerve was possible in all patients. The technique proposed here for harvesting the Accessory Nerve for transfer made its identification and dissection easier.
David G Kline - One of the best experts on this subject based on the ideXlab platform.
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surgical outcomes of 111 spinal Accessory Nerve injuries
Neurosurgery, 2003Co-Authors: Robert L Tiel, David G KlineAbstract:OBJECTIVE: Iatrogenic injury to the spinal Accessory Nerve is not uncommon during neck surgery involving the posterior cervical triangle, because its superficial course here makes it susceptible. We review injury mechanisms, operative techniques, and surgical outcomes of 111 surgical repairs of the spinal Accessory Nerve. METHODS: This retrospective study examines clinical and surgical experience with spinal Accessory Nerve injuries at the Louisiana State University Health Sciences Center during a period of 23 years (1978-2000). Surgery was performed on the basis of anatomic and electrophysiological findings at the time of operation. Patients were followed up for an average of 25.6 months. RESULTS: The most frequent injury mechanism was iatrogenic (103 patients, 93%), and 82 (80%) of these injuries involved lymph node biopsies. Eight injuries were caused by stretch (five patients) and laceration (three patients). The most common procedures were graft repairs in 58 patients. End-to-end repair was used in 26 patients and neurolysis in 19 patients if the Nerve was found in continuity with intraoperative electrical evidence of regeneration. Five neurotizations, two burials into muscle, and one removal of ligature material were also performed. More than 95% of patients treated by neurolysis supported by positive Nerve action potential recordings improved to Grade 4 or higher. Of 84 patients with lesions repaired by graft or suture, 65 patients (77%) recovered to Grade 3 or higher. The average graft length was 1.5 inches. CONCLUSION: Surgical exploration and repair of spinal Accessory Nerve injuries is difficult. With perseverance, however, these patients with complete or severe deficits achieved favorable functional outcomes through operative exploration and repair.
S. E. Mackinnon - One of the best experts on this subject based on the ideXlab platform.
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Treatment of a proximal Accessory Nerve injury with Nerve transfer
Laryngoscope, 2004Co-Authors: Christine B. Novak, S. E. MackinnonAbstract:Objective and Hypothesis: This study presents a case report of a patient who sustained an iatrogenic proximal Accessory Nerve injury that was treated with a medial pectoral to Accessory Nerve transfer. Study Design: Case study. Materials and Methods: Chart of one patient who was treated with a medial pectoral to Accessory Nerve transfer was reviewed. Results: Five months after excision of a branchial cyst that resulted in a very proximal injury to the Accessory Nerve, this patient underwent a medial pectoral to Accessory Nerve transfer. At final follow-up, 3 years after surgery, the patient had full abduction overhead with some residual shoulder/scapular discomfort and mild scapular winging. Conclusion: The medial pectoral to Accessory Nerve transfer provides a viable surgical option with good reinnervation of the trapezius muscle in patients with a proximal Accessory Nerve injury where standard Nerve repair or graft techniques are not feasible.
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patient outcome after surgical management of an Accessory Nerve injury
Otolaryngology-Head and Neck Surgery, 2002Co-Authors: Christine B. Novak, S. E. MackinnonAbstract:OBJECTIVE: This study assessed patient outcome following surgical reconstruction of the Accessory Nerve after an iatrogenic injury.STUDY DESIGN: A retrospective chart review of 8 patients was performed.RESULTS: There were 3 men and 5 women in the study, and the mean time between injury and Nerve graft/repair surgery was 5 months. Four injuries were sustained during a lymph node biopsy. Electromyography revealed a complete Accessory Nerve injury in all cases. In 6 cases, a Nerve graft was required (mean length, 3.6 cm), and in 2 cases, a direct Nerve repair was possible. The trapezius muscle was successfully reinnervated in all cases. In total, full shoulder abduction was achieved in 6 cases; in the remaining 2 cases, the patients achieved shoulder abduction to 90°.CONCLUSION: Functional deficit after Accessory Nerve injury is significant. Nerve graft/repair reconstruction reliably yields a satisfactory result, providing good scapular rotation and thus good shoulder function.
