Artikel
Iatrogenic lesions of the spinal accessory nerve relating to lymph note biopsy
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Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: In the decision to perform a lymph node excision in the neck the possibility to harm the accessory nerve resulting in severe motor deficit and pain should be considered.
Methods: Between 1994 and 2009, 52 patients were operated in our department because of iatrogenic lesions of the XI. cranial nerve. 35 of them (67%) underwent a previous lymph node excision – only two of them with a pathologic histology of a CLL and a histiocytosis. All patients presented with severe paresis of the trapezius muscle and a markedly reduced abduction of the shoulder. Additional neck and shoulder pain was existent in 48 of 52 cases. In 11 cases, external neurolysis could be performed, 11 patients underwent a end-to-end anastomosis and in 27 cases autologous nerve grafting was necessary – in 2 patients no distal nerve ending could be found, so that no reconstruction was possible.
Results: After a mean follow-up of 11.2 months, 13 of 52 recovered completely and at least 32 patients improved significantly; but 7/52 (13%) remained unchanged.
Conclusions: Because of a mean age of 37 years, the social and economic consequences of iatrogenic accessory nerve lesions - including the motor restriction and the chronic pain - are immense. We should consider this aspect before indicating a lymph note biopsy.