Peripheral Nerve Anatomy Revisited: Modern Requirements for Neuroimaging and Microsurgery

Abstract

Detailed anatomic investigation of peripheral nerve topography underlies the correct application of intraoperative neuromonitoring (IONM) and ultrasonography, both well-established methods to prevent nerve palsy during surgical operations and to elucidate pathomechanisms in disease. In this study, we analyzed the anatomy of selected peripheral nerves in the head and neck regions to improve the outcome of endocrine and migraine surgeries. Anatomic dissections of 204 hemilarynges were performed to study the topography of the inferior laryngeal nerve (ILN). Measurements were taken from the lower rim of the cricoid and from the Zuckerkandl tubercle to the beginning of the furcation of the ILN. For the analysis of peripheral nerves contributing to migraine pathogenesis, 22 hemifaces were investigated by dissection and ultrasonography. The supratrochlear and supraorbital nerves and their relationship to the corrugator supercilii muscle are described. For identification of the ILN, the cricoid offers a suitable intraoperative landmark. A single branch existed in 5% of specimens on the left side and in 3% on the right side. Bifurcation was present in 72.5% and 62% and trifurcation in 18% and 29% of cases, respectively. IONM signals from the vagus nerve were positive if derived proximal to and negative if derived distal to the branching off of a nonrecurrent ILN (nrILN). By ultrasonographic identification of a brachiocephalic trunk, an nrILN could be excluded. For migraine surgery, possible compression points of the supratrochlear and supraorbital nerves were identified, and a workflow algorithm for ultrasound visualization of these nerves is provided. Anat Rec, 302:1325-1332, 2019.

Efficacy and Safety of Migraine Surgery

“…Of these, 234 articles were eligible for full-text review. A total of 38 clinical studies, 3,8–44 and 30 anatomical studies 45–74 met our selection criteria and were included in the review.…”

“…A total of 30 anatomical studies were included and published in this bibliometric analysis 45–74 . The vast majority of these papers (n = 24; 77.4%) are published in plastic surgery journals.…”

Introduction: Thematic Papers Issue on “Advances in Our Understanding of the Morphological Response to Injury in the Peripheral Nervous System”

“…In the field of human PNS research, Marko Konschake and colleagues (Konschake et al, , this issue) contributes with a summary of their translational research on peripheral nerve anatomy. He and his coworkers carefully study intraoperative neuromonitoring, which is now being used in many surgical disciplines, often in combination with ultrasound neuroimaging.…”

How small can small nerves be for diagnostic ultrasonography?

“…Die Sonografie ist die Methode der Wahl für die Bildgebung des peripheren Nervensystems [1]. Klinisch ist die Darstellung insbesondere der kleinen peripheren Nerven für folgende Anwendungen relevant: (i) ihre Lokalisierung, um Schäden während chirurgischer oder anderer invasiver Eingriffe zu vermeiden [2][3][4], (ii) die Zielführung applizierbarer Therapeutika oder chirurgischer Eingriffe an diesen Nerven [5][6][7][8][9], und (iii) zur Bestimmung ihres Kalibers für die Beurteilung von kompressiven, entzündlichen oder degenerativen Neuropathien [12][13][14][15][16][17][18].…”