Relations of the accessory nerve with the internal jugular vein: surgical implications in cervical lymph node clearances

Abstract

The position of the lateral branch of the accessory nerve in relation to the internal jugular vein is given variously by different authors. In surgery of the neck, and especially in conservative cervical lymph node clearances, the lateral branch of the accessory nerve is protected when it is situated lateral to the vein. However, when the nerve is medial to the vein there is a risk of damage to the internal jugular vein. A prospective preoperative study of 123 cervical lymph node clearances, as well as a dissection study of 5 fresh subjects, was carried out to determine the position of the lateral branch of the accessory nerve in relation to the internal jugular vein. The surgical study showed that the lateral branch of the nerve was anterior and lateral to the vein in 122 of the 123 clearances, while the cadaveric study found the nerve always anterior and lateral to the vein. Thus the risk of injuring the internal jugular vein during cervical lymph node clearances is very small. The differences observed by authors may be explained by collapse of the internal jugular vein observed during cadaveric dissections.

Refinements in the Technique for Repair of the Accessory Nerve

“…14 The accessory nerve reaches the upper part of the sternocleidomastoid muscle by perforating the deep cervical fascia at the level of the superior border of the thyroid cartilage. 15 In 80% of patients, the accessory nerve perforates the cleidomastoid portion of the sternocleidomastoid muscle, whereas in 20% the nerve runs posterior to it.…”

Accessory nerve: anatomy and surgical identification

“…Following its exit from the jugular foramen, most papers describe the spinal accessory nerve passing medial or lateral to the internal jugular vein. The lateral course is more common than the medial course, but the reported incidences of each vary widely in the literature 22C , 23C , 24C . Rarely, the spinal accessory nerve may pass through the vein 25L , 26L .…”

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

“…In a study performed in fresh anatomical specimens and in patients who underwent lymph node clearance, they found an anterolateral location of the nerve in all specimens and 123 out of 124 neck dissections. 33 In contrast, a recent and larger anatomical study performed in 30 cadavers described the trajectory of the nerve around the anterior wall of the IJV in 71.7% of cases and around the posterior wall in 28.3% of cases. 34 Others have described a way to localize CN XI at the site of its junction with the SCM within a range of 2.5 to 5 cm from the mastoid tip 32 however, since the mastoid process is highly variable, and the preferred site to locate the nerve in the MIKET approach should be along the vertical axis of the IJV, measuring it from the JP was deemed to be more helpful.…”