Artikel
Iatrogenic lesions of the spinal accessory nerve
Management iatrogener N.-accessorius-Läsionen
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Evaluation of the causes of iatrogenic injuries of the spinal accessory nerve and the presentation of the results after neurosurgical repair.
Methods
From 1994 to 2003, 30 patients were operated on in our department for iatrogenic lesions of the XI. cranial nerve. 21/30 patients underwent a previous lymph node exstirpation, 2/30 were injured during a selective peripheral denervation for spasmodic torticollis, the other 7 patients by different causes. The neurosurgical intervention was performed 0-19 months post-traumatically (mean, 7.2 months). All patients showed a paresis/ atrophy of the trapezius muscle, the abduction of the shoulder was markly reduced. Additional neck and/or shoulder pain was present in 28/30 cases. In 7 cases, the nerve was compressed by scar tissue and subsequently treated by external neurolysis. 10 patients underwent an end-to-end anastomosis; an autologous sural nerve grafting was necessary in 13 cases.
Results
After a mean follow-up of 12.6 months a complete recovery was found in 7/30 patients. 19/30 patients showed a partial relief of pain and weakness. Only 4 patients remained unchanged. The clinical findings after autologous nerve grafting, end-to-end reconstruction or external neurolysis did not show any significant difference.
Conclusions
Microsurgical reconstruction of an iatrogenic injury of the spinal accessory nerve is very promissing if the interval between trauma and surgical revision is less than 6 months. Up to 12 months, a partial recovery can be achieved, a longer delay will normally result in a bad outcome.