Sang Hyun Park1, Yoshua Esquenazi2, David G Kline3, Daniel H Kim2. 1. Department of Anesthesiology and Pain Medicine, Jeju National University Medical School, Jeju, Korea; 2. Department of Neurosurgery, The University of Texas Health Science Center at Houston Medical School, Houston, Texas; and. 3. Department of Neurosurgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.
Abstract
OBJECT: Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODS: This retrospective study examines the authors' clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8-44 months). RESULTS: Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. CONCLUSIONS: SAN injuries present challenges for surgical exploration and repair because of the nerve's size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.
OBJECT: Iatrogenic injuries to the spinal accessory nerve (SAN) are not uncommon during lymph node biopsy of the posterior cervical triangle (PCT). In this study, the authors review the operative techniques and surgical outcomes of 156 surgical repairs of the SAN following iatrogenic injury during lymph node biopsy procedures. METHODS: This retrospective study examines the authors' clinical and surgical experience with 156 patients with SAN injury between 1980 and 2012. All patients suffered iatrogenic SAN injuries during lymph node biopsy, with the vast majority (154/156, 98.7%) occurring in Zone I of the PCT. Surgery was performed on the basis of anatomical and electro-physiological findings at the time of the operation. The mean follow-up period was 24 months (range 8-44 months). RESULTS: Of the 123 patients who underwent graft or suture repair, 107 patients (87%) improved to Grade 3 functionality or higher using the Louisiana State University Health Science Center (LSUHSC) grading system. Neurolysis was performed in 29 patients (19%) when the nerve was found in continuity with recordable nerve action potential (NAP) across the lesion. More than 95% of patients treated by neurolysis with positive NAP recordings recovered to LSUHSC Grade 3 or higher. Forty-one patients (26%) underwent end-to-end repair, while 82 patients (53%) underwent graft repair, and Grade 3 or higher recovery was assessed for 90% and 85% of these patients, respectively. The average graft length used was 3.81 cm. Neurotization was performed in 4 patients, 2 of whom recovered to Grade 2 and 3, respectively. CONCLUSIONS: SAN injuries present challenges for surgical exploration and repair because of the nerve's size and location in the PCT. However, through proper and timely intervention, patients with diminished or absent function achieved favorable functional outcomes. Surgeons performing lymph node biopsy procedures in Zone I of the PCT should be aware of the potential risk of injury to the SAN.
Entities:
Keywords:
LSUHSC = Louisiana State University Health Science Center; NAP = nerve action potential; PCT = posterior cervical triangle; SAN = spinal accessory nerve; SCM = sternocleidomastoid muscle; iatrogenic injury; lymph node biopsy; nerve action potential; nerve injury; nerve repair; spinal accessory nerve
Authors: Soon-Hyun Ahn; Hyun Jun Hong; Soon Young Kwon; Kee Hwan Kwon; Jong-Lyel Roh; Junsun Ryu; Jun Hee Park; Seung-Kuk Baek; Guk Haeng Lee; Sei Young Lee; Jin Choon Lee; Man Ki Chung; Young Hoon Joo; Yong Bae Ji; Jeong Hun Hah; Minsu Kwon; Young Min Park; Chang Myeon Song; Sung-Chan Shin; Chang Hwan Ryu; Doh Young Lee; Young Chan Lee; Jae Won Chang; Ha Min Jeong; Jae-Keun Cho; Wonjae Cha; Byung Joon Chun; Ik Joon Choi; Hyo Geun Choi; Kang Dae Lee Journal: Clin Exp Otorhinolaryngol Date: 2017-01-03 Impact factor: 3.372