What are the surgical options for treatment of a spinal accessory nerve (SAN) injury?

Updated: Feb 09, 2018
  • Author: Rohan R Walvekar, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The surgical options are as follows:

  • Neurolysis

  • Primary nerve anastomosis

  • Cable graft (autograft, biosynthetic nerve guide or Neurotube)

  • Eden-Lange muscle transfer

Although serial examinations may differentiate patients who are appropriate for surgical reconstruction of the SAN from those patients who may be managed conservatively, in the case of clear SAN transection, immediate reconstruction at the time of nerve injury is recommended. In patients who present with trapezius muscle palsy with or without a history of neck surgery, the evaluating surgeon must determine the length of time that has elapsed from the initial onset of symptoms.

Previous studies have emphasized that the best outcomes of surgical repair occur if the surgery is performed within 3 months of the injury. [46, 47] Although this is a rational stance, other studies have reported good outcomes of SAN repair in patients with symptom duration of less than 20 months. Maldonado and Spinner reported on the successful use of a lateral pectoral nerve transfer, employing a supraclavicular approach, for SAN repair in two patients who presented 8 and 10 months postinjury. [48] The Eden-Lange muscle transfer procedure is recommended for cases of spontaneous trapezius palsy or cases in which the elapsed symptomatic time is greater than 20 months. [41]


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