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Cranial Nerves: Overview and Anatomy01:19

Cranial Nerves: Overview and Anatomy

The cranial nerves are an important part of the complex network of nerves in the human body. These nerves emerge directly from the brain and are responsible for transmitting essential information between the brain and various parts of the head and neck. There are 12 pairs of cranial nerves, systematically numbered using Roman numerals from I to XII, beginning from the anterior and moving to the posterior of the brain. Each cranial nerve is uniquely identified by names that reflect its function...
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Accessory nerve: anatomy and surgical identification.

S Lloyd1

  • 1Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK. SKLloyd@blueyonder.co.uk

The Journal of Laryngology and Otology
|September 26, 2007
PubMed
Summary

Surgeons can now identify the accessory nerve (XIth cranial nerve) using various methods to prevent shoulder syndrome during neck surgery. Sparing this nerve in dissections offers equal cancer control without functional loss.

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Area of Science:

  • Neurosurgery
  • Anatomy
  • Surgical Oncology

Background:

  • The XIth cranial nerve (accessory nerve) innervates sternocleidomastoid and trapezius muscles.
  • Iatrogenic injury to the accessory nerve during neck surgery causes 'shoulder syndrome'.
  • Historically, the accessory nerve was often sacrificed during radical neck dissection for oncological reasons.

Purpose of the Study:

  • To systematically review methods for identifying the accessory nerve during neck surgery.
  • To assess the reliability of different accessory nerve identification techniques.
  • To describe the detailed anatomy of the accessory nerve in the neck.

Main Methods:

  • Systematic literature review of accessory nerve identification techniques.
  • Analysis of anatomical descriptions and surgical approaches.
  • Evaluation of the reliability and efficacy of described methods.

Main Results:

  • Accessory nerve sacrifice during neck dissection is often unnecessary and oncologically unfounded.
  • Accessory nerve sparing selective neck dissection demonstrates equal oncological efficacy.
  • Multiple methods exist for accessory nerve identification, but its path is highly variable, lacking a single reliable landmark.

Conclusions:

  • Accessory nerve sparing neck dissection is oncologically sound and prevents 'shoulder syndrome'.
  • Understanding detailed anatomy and employing reviewed identification methods can minimize iatrogenic injury.
  • Further refinement of identification techniques is crucial for preserving accessory nerve function in neck surgery.