New insights into pathways of the accessory nerve and transverse cervical artery for distal selective accessory nerve blockade
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Background: The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade. Methods: This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination. Results: The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I-IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection. Conclusions: The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.
Abstract
Background: The aim of this study was to clarify the topographical relationship between the accessory nerve (AN) and transverse cervical artery (TCA) to provide safe and convenient injection points for AN blockade. Methods: This study included 21 and 30 shoulders of 14 embalmed Korean adult cadavers and 15 patients, respectively, for dissection and ultrasound (US) examination. Results: The courses of the TCA and AN in the scapular region were classified into four types based on their positional relationships. Type A indicated the nerve that was medial to the artery and ran parallel without changing its location (38%). In type B (38%), the nerve was lateral to the artery and ran parallel without changing its location. In type C (19%), the nerve or artery traversed each other only once during the whole course. In type D (5%), the nerve or artery traversed each other more than twice forming a twist. At the levels of lines I-IV, the nerve was relatively close to the artery (approximately 10 mm). TCAs were observed in all specimens around the superior angle of the scapula at the level of line II, whereas they were not found below line VI. In US images of the patients, the TCA was commonly observed at the level of line II (93.3%) where all ANs and TCAs were observed in cadaveric dissection. Conclusions: The results expand the current knowledge of the relation between the AN and TCA, and provide helpful information for selective diagnostic nerve blocks in the scapular region.
참고문헌 (20)
- Shiozaki K, "Anatomical study of accessory nerve innervation relating to functional neck dissection", J Oral Maxillofac Surg, 65, pp.22~29 (2007)
- Nystrom NA, "Surgical fasciectomy of the trapezius muscle combined with neurolysis of the Spinal accessory nerve; results and long-term follow-up in 30 consecutive cases of refractory chronic whiplash syndrome", J Brachial Plex Peripher Nerve Inj, 5, pp.7~ (2010)
- Chandawarkar RY, "Management of iatrogenic injury to the spinal accessory nerve", Plast Reconstr Surg, 111, pp.611~617 (2003)
- Cappiello J, "Shoulder disability after different selective neck dissections(levels II-IV versus levels II-V) : a comparative study", Laryngoscope, 115, pp.259~263 (2005)
- Restrepo CE, "Expanding what is known of the anatomy of the spinal accessory nerve", Clin Anat, 28, pp.467~471 (2015)
- Bremner-Smith AT, "Sensory pathways in the spinal accessory nerve", J Bone Joint Surg Br, 81, pp.226~228 (1999)
- Bodner G, "Ultrasonography of the accessory nerve : normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy", J Ultrasound Med, 21, pp.1159~1163 (2002)
- Kessler J, "Course of the spinal accessory nerve relative to the brachial plexus", Reg Anesth Pain Med, 32, pp.174~176 (2007)
- Townsley P, "Ultrasound-guided spinal accessory nerve blockade in the diagnosis and management of trapezius muscle-related myofascial pain", Anaesthesia, 66, pp.386~389 (2011)
- Canella C, "Anatomical study of phrenic nerve using ultrasound", Eur Radiol, 20, pp.659~665 (2010)
- Li AE, "MRI findings of spinal accessory neuropathy", Clin Radiol, 71, pp.316~320 (2016)
- Cappiello J, "The spinal accessory nerve in head and neck surgery", Curr Opin Otolaryngol Head Neck Surg, 15, pp.107~111 (2007)
- 최창훈, "우측 경련성 사경 수술적 치료 후 좌측에 발병한 경련성 사경 환자에서 시행된 국소마취제 신경차단술의 임상효과-증례보고-", The Korean Journal of Pain, 20(2), pp.30~30 (2007), 대한통증학회
- Ramamurthy S, "A simple technic for block of the spinal accessory nerve", Anesth Analg, 57, pp.591~593 (1978)
- Scott PV, "Asystole from tetanic stimulation of the accessory nerve", Anaesthesia, 51, pp.1148~1150 (1996)
- Waldman SD, "Atlas of interventional pain management", pp.103~ (2009), Saunders
- Symes A, "Variations in the surface anatomy of the spinal accessory nerve in the posterior triangle", Surg Radiol Anat, 27, pp.404~408 (2005)
- Hagert CG, "Hyperpressure in the trapezius muscle associated with fibrosis", Acta Orthop Scand, 61, pp.263~265 (1990)
- Jobe CM, "Spinal accessory nerve in a trapezius-splitting surgical approach", J Shoulder Elbow Surg, 5, pp.206~208 (1996)
- Ogawa R, "Clinical and anatomical study of superficial cervical artery flaps : retrospective study of reconstructions with 41 flaps and the feasibility of harvesting them as perforator flaps", Plast Reconstr Surg, 118, pp.95~101 (2006)