Anatomic Alert: Spinal accessory nerve traversing a fenestrated internal jugular vein.

We present a case of the spinal accessory nerve traversing a fenestrated internal jugular vein. Awareness of this variant may be important in neurosurgical procedures that involve upper cervical exposures.

Ultrasonic identification of internal jugular vein fenestration.

OBJECTIVE: Anatomic variations have curicial importance during neck surgery. We present a fenestrated internal jugular vein variation and the accessory nerve passing through it. Also, we discuss preoperative diagnosis of this variation using ultrasonography. METHOD: The possible recognition of this variation by ultrasonography is introduced. RESULTS: The accessory nerve in an internal jugular vein fenestration can be seen using ultrasonography. CONCLUSION: Preoperative identification of this rare variation may secure surgeon from potential complications.

A persistent left superior vena cava, with the accessory nerve passing through a duplicate segment of the left internal jugular vein: a unique presentation.

The internal jugular vein and the spinal accessory nerve are important landmarks during neck dissection; unexpected variations in their positions can result in inadvertent iatrogenic damage to adjacent structures. We report the case of a 79-year-old man who was found during neck dissection to have a duplicate segment of his left internal jugular vein (IJV), a persistent left superior vena cava, and an absent right superior vena cava. The spinal accessory nerve passed through the duplicate section of the IJV. A MEDLINE search found no previously reported case of these anomalies occurring together. We also review 10 previously reported cases of IJV duplication. Finally, we discuss the embryologic and anatomic background of these malformations so that otolaryngologists may be aware that identification of such anomalies may help to prevent postoperative morbidity.

Absence of the sternocleidomastoid muscle in a patient that underwent neck dissection for squamous cell carcinoma of the tongue.

The congenital absence of a skeletal muscle is a rare cause of congenital muscular torticollis, and the condition is associated with various unusual anatomical structures. We describe a rare case of congenital absence of the sternocleidomastoid muscle associated with squamous cell carcinoma of the tongue in a patient who underwent neck dissection. In this case, both the external jugular vein and the spinal accessory nerve were absent. However, we found that branches of the C3 nerve extended from the cervical plexus to the trapezius muscle and seemed to be acting as trapezius muscle motor nerves in place of the accessory nerve. After the operation, the patient was able to lift and abduct his right arm, and his shoulder did not droop.

A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves.

OBJECTIVE: The accessory nerve has cranial and spinal roots. The cranial roots emerge from the medulla, whereas the spinal roots arise from motor cells within the ventral horn of C1-C7 segments of the spinal cord. Communications have been described between the spinal accessory nerve rootlets and the dorsal rootlets of cervical spinal nerves. In the present case, we report a communication that has not been reported before and discuss the functional anatomy. MATERIALS AND METHODS: During the dissection of the craniovertebral junction of a 67-year-old formalin-fixed adult male cadaver, a connection between the spinal accessory nerve rootlets and the dorsal rootlets of the cervical spinal nerves was observed. RESULTS: A communication between the spinal rootlets of the accessory nerve and the dorsal roots of cervical spinal nerves was present on the right and left side. On the right, a communication between the accessory nerve spinal rootlet and the dorsal rootlet of the fourth cervical spinal nerve existed. On the left, there were two branches from the lowest accessory nerve spinal rootlet, one run ventrally and the other dorsally to the spinal rootlet and reached the dorsal root of third cervical spinal nerve. The dorsal root of C1 did not exist on either the right or the left side. Further, an unusual spinal accessory nerve formation was also observed. DISCUSSION: This case does not fit into any of the previously described classifications in the literature. Therefore, the different variations concerning the communications between the spinal rootlets of the accessory nerve and the cervical spinal nerves should be kept in mind during both surgical, especially radical neck dissections, and nonsurgical evaluations.

Four cases of spinal accessory nerve passing through the fenestrated internal jugular vein.

PURPOSE: Neck dissection (ND) is an important technique for the treatment of cervical lymph node metastasis in patients with head and neck cancer. Since the introduction of functional ND (FND), various modifications have been made to reduce the adverse effects of radical ND. Recently, many investigators have documented cases of FND with preservation of the spinal accessory nerve (SAN) and/or the sternocleidomastoid muscle, which have contributed to improve the quality of life following ND. For this type of ND, special attention must be paid to identify the SAN and the internal jugular vein (IJV). METHODS: We performed 123 NDs over 2 years at the Department of Otolaryngology, Head and Neck Surgery, Kobe University Hospital. We collected data of all patients who underwent NDs by retrospectively reviewing the relevant hospital medical records and operative notes. RESULTS: In 4 out of 123 NDs (3.3%), an anomaly of the SAN passing through the fenestrated IJV was observed. CONCLUSION: Although this anomaly is rare, head and neck surgeons should be aware of this anomalous relationship between the SAN and the IJV in order to avoid accidental injury to these structures during ND.

[High duplication of an internal jugular vein]. / Hohe inkomplette Duplikatur einer Vena jugularis interna.

The internal jugular vein is an important landmark in most cervical operations. The surgeon should know the exact position and possible variations to prevent complications. We report on a duplicated internal jugular vein, which is a rare anatomic anomaly and discuss aetiology and appearance of this malformation and the possible affecting of the accessory nerve.

A rare anatomical variation of the spinal accessory nerve.

Considerable inter- and intra-individual anatomical differences can be observed during neck dissections. In this case report, we describe an unusual relationship of the accessory nerve to the internal jugular vein.

Relationship between the spinal accessory nerve and the posterior root of the first cervical nerve in spasmodic torticollis and common autopsy cases.

Operative findings on the topographical relationship of the spinal root of the accessory nerve to the posterior root of the first cervical nerve in 30 patients suffering from severe spasmodic torticollis are compared with anatomical findings in 50 common autopsy cases. Anastomoses between the SRAN and DRC 1 were found much more frequently in torticollis-patients (87%:46%). These results support the hypothesis of a peripheral pathogenic factor in the etiology of ST.