Ultrasound Visualization of the Spinal Accessory Nerve In聽Vivo

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• 作者：Seyed A. Mirjalili ; M.D. ; P.G.Dip.Sci. ; Jill C. Muirhead ; D.M.U. ; Mark D. Stringer ; M.S. ; F.R.C.S. ; ^{mark.stringer@anatomy.otago.ac.nz}
• 关键词：iatrogenic nerve injury ; neck surgery ; anatomy ; lymph node biopsy
• 刊名：Journal of Surgical Research
• 出版年：2012
• 期刊代码：299_00224804
• 类别：med
• 出版时间：1 June, 2012
• 卷：175
• 期：1
• 页码：e11-e16
• 文件大小：338 K

摘要

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class="h4">Background

Inadvertent injury of the spinal accessory nerve during surgical procedures is a cause of significant morbidity with medicolegal repercussions. Surface anatomy is an unreliable guide to the nerve鈥檚 location. We suggest that ultrasound can be used to map the course of the nerve in the posterior triangle of the neck.

class="h4">Materials and Methods

Fifty healthy subjects (28 females, mean age 37 y) were scanned using a VF13-5 linear probe and a Siemens Sonoline Antares ultrasound machine (Siemens Medical Solutions USA Inc., Malvern, PA). The caliber, course, and distribution of the nerve in the posterior triangle of the neck were recorded.

class="h4">Results

The nerve was visualized bilaterally in all subjects, running superficially across the posterior triangle with either a straight (56%) or tortuous (44%) course at a depth of about 3 mm beneath the skin surface. It had a mean caliber of 0.76 卤 0.12 mm. It exited the posterior border of sternocleidomastoid at a mean of 6.7 (4.0-9.4) cm below the mastoid process and 1.1 (0.1-2.1) cm above the great auricular point and penetrated the anterior border of trapezius 5.4 (2.1-9.2) cm above the clavicle. Importantly, 58%of nerves divided into 2-4 branches before penetrating trapezius; the nerve branched on at least one side in 49 of 50 individuals.

class="h4">Conclusions

The spinal accessory nerve and its anatomical variants can be consistently and reliably demonstrated by ultrasound in normal individuals. Surface anatomical landmarks are not a reliable guide to the position and course of the nerve in the posterior triangle. Preoperative mapping of the nerve with ultrasound may reduce the risk of iatrogenic injury.