Brown Henry
The Harvard University School of Medicine, Boston, Massachusetts 02115, USA.
Exp Biol Med (Maywood). 2002 Sep;227(8):570-8. doi: 10.1177/153537020222700804.
The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.
副神经丛这一术语可定义为副神经及其与其他神经（主要是脑神经、颈神经和交感神经）在颅内和颅外的所有连接。这个术语并非新出现的。本综述探讨了其在头颈癌和动脉粥样硬化中的应用解剖学。几个世纪以来，对神经和血管解剖学以及胚胎学的一般性研究为描述该神经丛奠定了理解基础。在过去的一个世纪里，人们对其解剖结构和血液供应有了更好的认识。几乎整个神经丛对头、颈和上肢运动及感觉功能的重要性已被认识到。基于这种认识，颈部手术清扫术已变得越来越保守。本文追溯了这一历史进程。即使是关于副神经丛的最新解剖学研究也揭示了许多我们尚不熟悉的结构。这些结构可能为古典解剖学家所知，但未记录在容易获取的文献中，或者根本没有记录。人体和比较解剖学研究表明，尽管在同一物种中其整体功能几乎相同，但该神经丛的组成及其血液供应差异很大。因此，这些结构中任何一个的缺失在不同个体中可能产生非常不同的后果。作为这一说法的推论，文中给出的数据表明，在颈部手术清扫术中，即使不切断副神经本身也可能导致严重损伤。此外，文中给出的数据支持这样一种理论，即动脉粥样硬化通过阻塞该神经丛及其紧密相连的臂丛神经的血管，很可能导致其缺血性功能障碍，常常伴有疼痛。最后，阐述了关于解剖学问题、方法、结果以及强调保守性的手术程序可能改进方面的证据和理论。
