TY - JOUR
T1 - An anatomic study of the spinal accessory nerve
T2 - Extended harvest permits direct nerve transfer to distal plexus targets
AU - Vathana, Torpon
AU - Larsen, Mikko
AU - De Ruiter, Godard C.W.
AU - Bishop, Allen T.
AU - Spinner, Robert J.
AU - Shin, Alexander Y.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007
Y1 - 2007
N2 - An anatomic study of the distal spinal accessory nerve (SAN) to determine the number of myelinated axons and feasibility of posterior harvest for direct neurotization of distal targets was performed. Ten fresh human cadavers were studied. A supraclavicular approach was performed followed by a posterior approach. The relationship of the SAN to bony landmarks (T1 spinous process, acromioclavicular joint, posterolateral corner of the acromium, and angle at the superior medial border of the scapula) as well as maximal harvestable length was recorded. After posterior dissection, the SAN was mobilized and the ability to reach both anterior infraclavicular and posterior targets was assessed. Axon counts were also performed at the proximal, mid, and distal points along the course of the nerve. The posteriorly harvested SAN was identified reliably with respect to bony landmarks. When harvested posteriorly, the SAN could reach the infraclavicular part of the brachial plexus (i.e., terminal branches), and posteriorly, the suprascapular nerve (SSN) both proximal and distal to the suprascapular ligament, the latter for selective reinnervation of the infraspinatus branch. The average number of myelinated fibers at the proximal end of the nerve was 1,328 axons, at the mid-way point was 1,021 axons, and at terminal end of the nerve was 817 axons. Harvest of the SAN from a posterior approach based on these landmarks is feasible, allowing direct transfer of the nerve to the infraclavicular brachial plexus and to the SSN both proximal and distal to the suprascapular ligament, without the use of interposition nerve grafts.
AB - An anatomic study of the distal spinal accessory nerve (SAN) to determine the number of myelinated axons and feasibility of posterior harvest for direct neurotization of distal targets was performed. Ten fresh human cadavers were studied. A supraclavicular approach was performed followed by a posterior approach. The relationship of the SAN to bony landmarks (T1 spinous process, acromioclavicular joint, posterolateral corner of the acromium, and angle at the superior medial border of the scapula) as well as maximal harvestable length was recorded. After posterior dissection, the SAN was mobilized and the ability to reach both anterior infraclavicular and posterior targets was assessed. Axon counts were also performed at the proximal, mid, and distal points along the course of the nerve. The posteriorly harvested SAN was identified reliably with respect to bony landmarks. When harvested posteriorly, the SAN could reach the infraclavicular part of the brachial plexus (i.e., terminal branches), and posteriorly, the suprascapular nerve (SSN) both proximal and distal to the suprascapular ligament, the latter for selective reinnervation of the infraspinatus branch. The average number of myelinated fibers at the proximal end of the nerve was 1,328 axons, at the mid-way point was 1,021 axons, and at terminal end of the nerve was 817 axons. Harvest of the SAN from a posterior approach based on these landmarks is feasible, allowing direct transfer of the nerve to the infraclavicular brachial plexus and to the SSN both proximal and distal to the suprascapular ligament, without the use of interposition nerve grafts.
KW - Brachial plexus
KW - Distal spinal accessory nerve
KW - Neurotization
UR - http://www.scopus.com/inward/record.url?scp=35948968426&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=35948968426&partnerID=8YFLogxK
U2 - 10.1002/ca.20545
DO - 10.1002/ca.20545
M3 - Article
C2 - 17879303
AN - SCOPUS:35948968426
SN - 0897-3806
VL - 20
SP - 899
EP - 904
JO - Clinical Anatomy
JF - Clinical Anatomy
IS - 8
ER -