Lloyd S
Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK.
J Laryngol Otol. 2007 Dec;121(12):1118-25. doi: 10.1017/S0022215107000461. Epub 2007 Sep 25.
The XIth cranial nerve or accessory nerve provides the motor supply to the sternocleidomastoid and trapezius muscles. It is frequently encountered during neck surgery, and as such is at risk of iatrogenic injury, resulting in the 'shoulder syndrome'. Historically, the nerve was sacrificed on oncological grounds during radical neck dissection. However, the basis for sacrifice is unfounded in the majority of cases, and accessory nerve sparing selective neck dissection has equal oncological efficacy. The path of the nerve in the neck is very variable, and there is not a wholly reliable landmark for its identification. However, there are a number of methods described in the literature to guide the surgeon in its identification. This paper provides a systematic review of all the methods available for identification of the accessory nerve, and comments on the reliability of each. In doing so, the detailed anatomy of the accessory nerve is also described.
第十一对颅神经即副神经，为胸锁乳突肌和斜方肌提供运动神经支配。在颈部手术中经常会遇到该神经，因此存在医源性损伤的风险，可导致“肩部综合征”。过去，在根治性颈清扫术中，出于肿瘤学原因会牺牲该神经。然而，在大多数情况下，牺牲该神经的依据并不成立，保留副神经的选择性颈清扫术具有同等的肿瘤学疗效。该神经在颈部的走行变化很大，且没有完全可靠的标志用于识别它。不过，文献中描述了多种方法来指导外科医生识别该神经。本文对所有可用于识别副神经的方法进行了系统综述，并对每种方法的可靠性进行了评论。在此过程中，还描述了副神经的详细解剖结构。
