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Surgical anatomy of the spinal accessory nerve: review of the literature and case report of a rare anatomical variant

Published online by Cambridge University Press:  08 June 2016

J Overland ,
J C Hodge ,
O Breik  and
S Krishnan
J Overland*
Affiliation:
ENT Department, Royal Adelaide Hospital, Australia
J C Hodge
Affiliation:
ENT Department, Royal Adelaide Hospital, Australia
O Breik
Affiliation:
ENT Department, Royal Adelaide Hospital, Australia
S Krishnan
Affiliation:
ENT Department, Royal Adelaide Hospital, Australia
*
Address for correspondence: Dr Joseph Overland, ENT Department, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia E-mail: [email protected]
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Abstract

Objective:

To evaluate the prevalence of variations in the anatomical route of the spinal accessory nerve from the base of the skull to the point where it enters the trapezius muscle. A case report is used to demonstrate an example of a rare but clinically important anatomical variant of this nerve.

Methods:

An independent review of the literature using Medline, PubMed and Q Read databases was performed using combinations of terms including ‘spinal accessory nerve’, ‘anatomy’, ‘surgical anatomy’, ‘anatomical variant’, ‘cranial nerve XI’ and ‘shoulder syndrome’.

Results:

Our report demonstrates marked variation in spinal accessory nerve anatomy. At the point of crossing over the internal jugular vein, the spinal accessory nerve passes most commonly laterally (anterior) to the internal jugular vein. The reported incidence of this lateral relationship varies from 67 to 96 per cent. The nerve can also pierce the internal jugular vein, as demonstrated in our case study, with incidence ranging from 0.48 to 3.3 per cent.

Conclusion:

Anatomical variations of the spinal accessory nerve are not uncommon, and it is important for the surgeon to be aware of such variations when undertaking surgery in both the anterior and posterior triangles of the neck.

Keywords

Accessory NerveAnatomyAnatomic VariationCranial Nerves
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 10 , October 2016 , pp. 969 - 972
Copyright
Copyright © JLO (1984) Limited 2016 

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