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Extracranial spinal accessory nerve injury

T R Donner1, D G Kline

  • 1Department of Neurosurgery, Louisiana State University Medical Center School of Medicine, New Orleans.

Neurosurgery
|June 1, 1993
PubMed
Summary

Accessory nerve injury, often from iatrogenic causes during surgery, leads to trapezius weakness. Surgical repair improved function in many patients with accessory nerve palsy.

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Area of Science:

  • Neurosurgery
  • Peripheral Nerve Surgery
  • Clinical Neurology

Background:

  • Extracranial accessory nerve injury is a recognized complication of various surgical procedures.
  • Iatrogenic causes, particularly during lymph node dissection or benign tumor removal, are the most common etiology.
  • Clinical presentation often involves trapezius muscle weakness, leading to shoulder dysfunction.

Purpose of the Study:

  • To review a consecutive series of patients with extracranial accessory nerve injury.
  • To analyze the etiologies, clinical presentation, diagnostic methods, and treatment outcomes.
  • To evaluate the effectiveness of surgical interventions for accessory nerve palsy.

Main Methods:

  • Retrospective review of 83 consecutive patients over a 12-year period.
  • Clinical examination to assess muscle strength (trapezius, sternocleidomastoid, serratus anterior).
  • Electromyographic (EMG) studies to evaluate nerve regeneration.
  • Surgical intervention for patients with no clinical or electrical evidence of regeneration, including neurolysis, nerve repair (suture/graft), and neurotization.

Main Results:

  • Iatrogenic injury was the most common cause (83 patients).
  • Trapezius weakness was present in all cases; sternocleidomastoid weakness was rare.
  • 44 patients underwent surgery; 8 had neurolysis, 31 had resection with repair (suture/graft).
  • Improved function was observed in both operative and nonoperative patient groups.

Conclusions:

  • Extracranial accessory nerve injury is frequently iatrogenic and results in trapezius weakness.
  • Clinical and electrodiagnostic evaluations are crucial for diagnosis and management.
  • Surgical interventions, including nerve repair and neurotization, can lead to functional improvement in selected cases.

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