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Channel-Assisted Microscopy for Contralateral C7 Nerve Transfer Through Posterior Cervical Keyhole Approach: An

Sen Jiang¹, Zhengcun Yan^2,3, Can Tang^2,3

¹Dalian Medical University, Dalian, China.

The Journal of Craniofacial Surgery

|June 3, 2026

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A posterior keyhole approach enables safe and feasible contralateral C7 nerve transfer, avoiding nerve grafting. This minimally invasive technique offers a short trajectory and favorable operative space for clinical application.

Area of Science:

Neurosurgery
Microsurgery
Anatomical Studies

Background:

Investigating the anatomical feasibility and operative safety of contralateral C7 nerve transfer.
Utilizing a posterior keyhole approach with a tubular retractor under microscopy.

Purpose of the Study:

To assess the anatomical feasibility and operative safety of contralateral C7 nerve transfer.
To evaluate a minimally invasive posterior keyhole approach for nerve transfer surgery.

Main Methods:

Microsurgical dissection on 10 fresh adult head and neck specimens.
Positioning specimens in a prone neck-flexed posture for bilateral 2 cm incisions.
Establishing a laminar-underlying epidural corridor for direct end-to-end neurorrhaphy.

Keywords:

Anatomy C7 nerve transfer keyhole technique minimally invasive spine

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Main Results:

Successful tension-free coaptation of bilateral C7 nerves in all specimens.
Prone neck-flexed position increased surgical exposure by improving the area of zone V.
Achieved direct anastomosis without nerve grafting, preserving cervical stability and avoiding nerve compression.

Conclusions:

The posterior keyhole approach is anatomically sound and technically reliable for contralateral C7 nerve transfer.
This approach offers advantages like minimal invasiveness, short trajectory, and favorable operative space.
Provides a robust anatomical foundation for clinical application in nerve transfer procedures.