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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Iatrogenic lesions of the spinal accessory nerve relating to lymph note biopsy

Meeting Abstract

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  • Ute M. Bäzner - Abteilung für Neurochirurgie, Universität Ulm/Günzburg, Deutschland
  • Christian R. Wirtz - Abteilung für Neurochirurgie, Universität Ulm/Günzburg, Deutschland
  • Gregor Antoniadis - Abteilung für Neurochirurgie, Universität Ulm/Günzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1813

DOI: 10.3205/10dgnc284, URN: urn:nbn:de:0183-10dgnc2840

Published: September 16, 2010

© 2010 Bäzner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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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.