Zacharewski Nicholas, Killory Brendan D
Department of Neurosurgery, Hartford Hospital, Hartford, Connecticut, United States.
Department of Neuroscience, Trinity College, Hartford, Connecticut, United States.
J Neurol Surg Rep. 2023 May 18;84(2):e59-e60. doi: 10.1055/s-0043-1768713. eCollection 2023 Apr.
Duplicate cranial nerves are fundamentally rare anatomical variants. Few case reports have documented cranial nerve duplication. One previous case report has reported a vagus nerve with a smaller secondary accessory nerve component. We present the first reported case of duplicate vagus nerves identical in size and thickness with otolaryngological diagnostic confirmation. A 25-year-old woman with seizures refractory to medical management decided to undergo placement of a vagus nerve stimulator. During carotid sheath microdissection, two parallel nerve tracts were identified. The two nerves were identical in size and width. Proximal dissection confirmed that the two nerves were independent of one another and neither was a branching segment. To confirm duplicate vagus nerves, otolaryngology was consulted intraoperatively and the duplicate nerves were verified. The vagus nerve stimulator was placed in typical fashion around the medial nerve. This is the first reported case of duplicate vagus nerves identical in size and with confirmation by otolaryngology. The authors would like to highlight the operative management of the vagus nerve stimulator placement as well as integrity of the diagnostic conclusions based on size, further dissection, and specialist consultation.
重复的颅神经是极为罕见的解剖变异。很少有病例报告记录颅神经重复的情况。之前有一份病例报告报道了一条伴有较小副神经成分的迷走神经。我们报告首例经耳鼻喉科诊断证实的大小和粗细相同的双侧重复迷走神经病例。
一名25岁患有药物难治性癫痫的女性决定接受迷走神经刺激器植入术。在颈动脉鞘显微解剖过程中，发现了两条平行的神经束。这两条神经的大小和宽度相同。近端解剖证实这两条神经相互独立，且均不是分支段。为了确认双侧重复迷走神经，术中咨询了耳鼻喉科，双侧重复神经得到了证实。迷走神经刺激器以典型方式置于内侧神经周围。
这是首例经报道的大小相同且经耳鼻喉科证实的双侧重复迷走神经病例。作者想强调迷走神经刺激器植入术的手术管理以及基于大小、进一步解剖和专家会诊得出的诊断结论的完整性。
