Restrepo Carlos E, Tubbs R Shane, Spinner Robert J
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Clin Anat. 2015 May;28(4):467-71. doi: 10.1002/ca.22492. Epub 2014 Dec 29.
The spinal accessory nerve (SAN) is classically considered a motor nerve innervating the sternocleidomastoid and trapezius muscles. Its anatomical relevance derives from the high prevalence of lesions following head and neck surgeries. As expected, trapezius weakness and atrophy are the most common findings; however, it is also commonly accompanied by pain and other sensory deficits that have no clear explanation, suggesting other functions. We have recently seen two patients presenting with an unrecognized sign, that is, subclavicular/pectoral asymmetry secondary to the SAN lesion. Retrospectively, we reviewed other patients with similar findings in our case series and in the literature. We discuss the anatomical connections of the SAN with the superficial cervical plexus and propose an explanation for this finding. Of the 41 patients in our series, we identified this sign in all who had preoperative photographs. New insights on the anatomy and connections of the SAN may account for the diversity of symptoms and signs presented following an operative intervention as well as the variability of its severity.
副神经（SAN）传统上被认为是支配胸锁乳突肌和斜方肌的运动神经。其解剖学意义源于头颈手术后病变的高发生率。正如预期的那样，斜方肌无力和萎缩是最常见的表现；然而，它通常还伴有疼痛和其他无法明确解释的感觉缺陷，这表明存在其他功能。我们最近见到了两名出现未被认识到的体征的患者，即副神经损伤继发的锁骨下/胸肌不对称。我们回顾性地分析了我们病例系列以及文献中其他有类似发现的患者。我们讨论了副神经与颈浅丛的解剖学联系，并对这一发现提出了解释。在我们的系列研究中的41例患者中，我们在所有有术前照片的患者中都发现了这一体征。对副神经的解剖学和联系的新见解可能解释了手术干预后出现的症状和体征的多样性及其严重程度的变异性。
