What are the general intraoperative details for the surgical 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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Specific recommendations related to each type of surgical repair have been discussed in previous sections (see Surgical therapy). Some additional recommendations include the following:

  • A generous incision and wide surgical exposure facilitate identification of the nerve. [57]

  • Anatomic landmarks are critical in identifying the proximal and distal ends of the SAN.

  • Intraoperative nerve stimulation can be a useful tool to identify the SAN.

  • Dissection of the distal stump of the nerve under the deep cervical fascia is relatively avascular and allows direct visualization of the nerve branches as they enter the trapezius. Efforts should be made to identify at least 1-3 branches.

  • Reinnervation of the upper portion of the trapezius is vital for correction of shoulder droop and is of high priority. This prevents the dragging pain associated with shoulder syndrome. The paralysis of the middle and lower portions of the trapezius is partially compensated for by the levator scapulae and rhomboid muscles. [34]

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