Spinal accessory nerve (SAN) injury mostly occurs during surgical procedures. SAN injury caused by manipulation therapy has been rarely reported. We present a rare case of SAN injury associated with manipulation therapy showing scapular winging and droopy shoulder. A 42-year-old woman visited our outpatient clinic complaining of pain and limited active range of motion (ROM) in right shoulder and scapular winging after manipulation therapy. Needle electromyography and nerve conduction study suggested SAN injury. Physical therapy (PT) three times a week for 2 weeks were prescribed. After a total of 6 sessions of PT and modality, the patient reported that the pain was gradually relieved during shoulder flexion and abduction with improved active ROM of shoulder. Over the course of 2 months follow-up, the patient reported almost recovered shoulder ROM and strength as before. She did not complain of shoulder pain any more.
Accessory Nerve Injuries* ; Accessory Nerve* ; Adult ; Ambulatory Care Facilities ; Electromyography ; Female ; Follow-Up Studies ; Humans ; Musculoskeletal Manipulations* ; Needles ; Neural Conduction ; Range of Motion, Articular ; Shoulder ; Shoulder Pain

Accessory Nerve ; transplantation ; Birth Injuries ; complications ; surgery ; Brachial Plexus Neuropathies ; etiology ; surgery ; Child, Preschool ; Early Medical Intervention ; Elbow ; Humans ; Infant ; Intercostal Nerves ; transplantation ; Nerve Transfer ; methods ; Radial Nerve ; surgery ; Sural Nerve ; transplantation ; Time Factors ; Treatment Outcome ; Ulnar Nerve ; transplantation

We report a case of multiple cervical schwannomas mimicking cervical nodal metastasis in a 45-year-old female patient with papillary thyroid carcinoma. Ultrasonography revealed a hypoechoic lesion with irregular contour in the left isthmus of the thyroid gland. A contrast-enhanced CT of the neck showed two well-circumscribed, cystic masses in the left cervical level II. The preoperative results of ultrasonography guided fine needle aspiration biopsy from both thyroid and lateral neck masses were papillary thyroid cancer and atypical cell, respectively. Considering clinical and imaging results, the lateral neck masses were suspected to be metastatic cervical lymphadenopathy. During surgery, however, we identified that two lateral neck masses were originated from spinal accessory nerve and cervical plexus. The pathologic examination confirmed that lateral neck masses were typical schwannomas. Before surgery, it is important to make every efforts to discriminate metastatic lymphadenopathy from the cystic neck mass in patients with papillary carcinoma.
Accessory Nerve ; Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Papillary ; Cervical Plexus ; Female ; Humans ; Lymph Nodes* ; Lymphatic Diseases ; Middle Aged ; Neck ; Neoplasm Metastasis ; Neurilemmoma* ; Thyroid Gland ; Thyroid Neoplasms* ; Tomography, X-Ray Computed ; Ultrasonography

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.
Accessory Nerve* ; Cerebellar Ataxia ; Electromyography ; Female ; Hoarseness ; Humans ; Hypesthesia ; Intracranial Hypertension ; Middle Aged ; Needles ; Neurilemmoma* ; Spinal Cord Diseases ; Spinal Nerve Roots

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.
Accessory Nerve ; Atlanto-Occipital Joint ; Atrophy ; Cranial Nerve Injuries ; Cranial Nerves ; Deglutition ; Deglutition Disorders ; Dislocations ; Electromyography ; Humans ; Larynx ; Magnetic Resonance Imaging ; Muscles ; Neck ; Palate, Soft ; Pharynx ; Physical Examination ; Pyriform Sinus ; Survivors ; Tongue

OBJECTIVE: Jugular foramen schwannomas are uncommon pathological conditions. This article is constituted for screening these tumors in a wide perspective. MATERIALS: One-hundred-and-ninty-nine patients published in 19 articles between 1984 to 2007 years was collected from Medline/Index Medicus. RESULTS: The series consist of 83 male and 98 female. The mean age of 199 operated patients was 40.4 years. The lesion located on the right side in 32 patients and on the left side in 60 patients. The most common presenting clinical symptoms were hearing loss, tinnitus, disphagia, ataxia, and hoarseness. Complete tumor removal was achieved in 159 patients. In fourteen patients tumor reappeared unexpectedly. The tumor was thought to originate from the glossopharyngeal nerve in forty seven cases; vagal nerve in twenty six cases; and cranial accessory nerve in eleven cases. The most common postoperative complications were lower cranial nerve palsy and facial nerve palsy. Cerebrospinal fluid leakage, meningitis, aspiration pneumonia and mastoiditis were seen as other complications. CONCLUSION: This review shows that jugular foramen schwannomas still have prominently high morbidity and those complications caused by postoperative lower cranial nerve injury are life threat.
Accessory Nerve ; Ataxia ; Cranial Nerve Diseases ; Cranial Nerve Injuries ; Cranial Nerves ; Facial Nerve ; Female ; Glossopharyngeal Nerve ; Hearing Loss ; Hoarseness ; Humans ; Male ; Mass Screening ; Mastoid ; Mastoiditis ; Meningitis ; Neurilemmoma ; Paralysis ; Pneumonia, Aspiration ; Postoperative Complications ; Tinnitus

BACKGROUNDIn recent years, transfer of the spinal accessory nerve to suprascapular nerve has become a routine procedure for restoration of shoulder abduction. However, the operation via the traditional supraclavicular anterior approach often leads to partial denervation of the trapezius muscle. The purpose of the study was to introduce transfer of the spinal accessory nerve through dorsal approach, using distal branch of the spinal accessory nerve, to repair the suprascapular nerve for restoration of shoulder abduction, and to observe its therapeutic effect.

METHODSFrom January to October 2003, a total of 11 patients with a brachial plexus injury and an intact or nearly intact spinal accessory nerve were treated by transferring the spinal accessory nerve to the suprascapular nerve through dorsal approach. The patients were followed up for 18 to 26 months [mean (23.5 +/- 5.2) months] to evaluate their shoulder abduction and function of the trapezius muscle. The outcomes were compared with those of 26 patients treated with traditional anterior approach. And the data were analyzed by Student's t test using SPSS 10.5.

RESULTSIn the 11 patients, the spinal accessory nerves were transferred to the suprascapular nerve through the dorsal approach successfully. Intact function of the upper trapezius was achieved in all of them. In the patients, the location of the two nerves was relatively stable at the level of superior margin of the scapula, the mean distance between them was (4.2 +/- 1.4) cm, both the nerves could be easily dissected and end-to-end anastomosed without any tension. During the follow-up, the first electrophysiological sign of recovery of the infraspinatus appeared at (6.8 +/- 2.7) months and the first sign of restoration of the shoulder abduction at (7.6 +/- 2.9) months after the operation, which were earlier than that after the traditional operation [(8.7 +/- 2.4) months and (9.9 +/- 2.8) months, respectively; P < 0.05]. The postoperative shoulder abduction was 62.8 degrees +/- 12.6 degrees after transfer of the spinal accessory nerve, better than that after the traditional (51.6 degrees +/- 15.7 degrees). All the 11 patients could extend and externally rotate the shoulder almost normally.

CONCLUSIONSThe accessory nerve transfer through dorsal approach is a safe and reliable procedure for the treatment of brachial plexus injury. Its postoperative effect is confirmed, which is better than that of the traditional operation.

Accessory Nerve ; surgery ; Adolescent ; Adult ; Brachial Plexus ; injuries ; Humans ; Male ; Nerve Transfer ; methods ; Shoulder Joint ; innervation ; physiology

OBJECTIVETo analysis the clinical presentation, radiological findings, surgical techniques and outcomes of jugular foramen (JF) schwannomas.

METHODSWe reviewed our 10-year experience in the surgical treatment of 17 patients suffered from JF schwannomas in Hua Shan Hospital, Shanghai. A total of 8 males and 9 females with a mean age of 42 years underwent surgical procedures. A relative long period of 53-month symptomatic history was shown before surgery. The main clinical presentation are vertigo and hearing difficulty in 10 cases, atrophy of unilateral muscles of tongue in 9 cases, involvement of lower cranial nerve in 8 cases. The classification of tumors was type A (at cerebellopontine angle with minimal enlargement of the JF) in five cases, type B (JF with intracranial extension) in 3 cases, type C (extracranial tumors with JF extension) in 2 cases and type D (dumbbell-shaped with both intra-and extracranial components) in 7 cases.

RESULTSFar lateral approaches were used in 10 cases, retrosigmoid suboccipital approaches were used in 5 cases. Submandibular approaches were selected in other 2 cases. Gross total removal was achieved in 12 cases, and subtotal removal in 5 cases. Follow-up revealed marked improvement from preoperative symptoms in 9 cases and no additional deficits in 3 cases. 5 cases suffered from additional neurological deficits. There were two cases of temporary hoarseness and gradually improved within follow-up. Two patients suffered from swallowing problems as a new deficit. One patient had facial palsy.

CONCLUSIONSJF schwannomas can be surgically treated with relative good outcomes. Surgical approaches should be tailored according to the tumor extension.

Accessory Nerve Diseases ; diagnosis ; surgery ; Adolescent ; Adult ; Cranial Nerve Neoplasms ; diagnosis ; surgery ; Female ; Glossopharyngeal Nerve Diseases ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Neurilemmoma ; diagnosis ; surgery ; Retrospective Studies ; Vagus Nerve Diseases ; diagnosis ; surgery

OBJECTIVETo describe a new method of accessory nerve defect reconstruction with sternocleidomastoid muscle-great auricular flap.

METHODSThirty-four cases receiving traditional radical neck dissection were divided into two groups: single neck dissection group (n = 19) and accessory nerve reconstruction group (n = 15). Surgical procedure of the reconstruction was described in detail. Postoperative shoulder functions were compared between the two groups.

RESULTSAccessory nerve reconstruction group experienced much better shoulder function recovery than that in single neck dissection group.

CONCLUSIONSReconstruction of accessory nerve defects with sternocleidomastoid muscle-great auricular nerve flap is simple, effective and complication-free.

Accessory Nerve ; surgery ; Accessory Nerve Injuries ; Adult ; Aged ; Carcinoma, Squamous Cell ; secondary ; surgery ; Ear ; innervation ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms ; pathology ; surgery ; Neck ; Neck Dissection ; methods ; Neck Muscles ; surgery ; Nerve Transfer ; methods ; Surgical Flaps ; Treatment Outcome

OBJECTIVEThe aim of this study was to examine the effects of deep branches of cervical plexus on trapezius muscle.

METHODSThe evoked electromyography of 32 trapezius of 16 SD rats was examined in different time and results obtained were processed by statistical methods.

RESULTSAfter cutting the accessory nerves, stimulating the deep branches of cervical plexus evoked the myoelectricity, the myoelectricity results varied according to different time.

CONCLUSIONThe deep branches of cervical plexus are another important motorial supply to trapezius muscles. After cutting the accessory nerves, if the branches were undamaged, the shoulder's function would be greatly preserved.

Accessory Nerve ; physiology ; Animals ; Cervical Plexus ; physiology ; Electromyography ; Male ; Muscle, Skeletal ; anatomy & histology ; innervation ; physiology ; Neck Dissection ; adverse effects ; Neck Muscles ; anatomy & histology ; injuries ; physiology ; Rats ; Rats, Sprague-Dawley ; Shoulder ; innervation