title: Approach to the cervical portion of the vagus nerve via the posterior cervical triangle: a cadaveric feasibility study with potential use in vagus nerve stimulation procedures.
abstract: OBJECTIVE
  The authors describe a technique in which the cervical portion of the vagus nerve is exposed during procedures such as neuroma resection or, more commonly, during the placement of a vagus nerve stimulator.
  
  
  METHODS
  To test their hypothesis that a posterolateral approach to the vagus nerve may be feasible and efficacious, the authors performed dissection of the left-sided vagus nerve in 13 adult cadavers. The carotid sheath was exposed via the posterior cervical triangle, and the vagus nerve was identified posterolaterally. Measurements were made of the length of available nerve, and the anatomical approach was documented. As part of a comparison study regarding the available length of nerve, the authors exposed the left vagus nerve in five additional adult cadavers via a standard anterior approach to the carotid sheath, and compared the results obtained with each technique. A mean length of 12 cm of the vagus nerve was isolated when using the posterior approach to the carotid sheath, whereas a mean length of 11 cm of the nerve was documented when using the anterior approach. With the aforementioned posterior approach, no obvious injury occurred to the vagus nerve or other local neurovascular structures such as the spinal accessory nerve.
  
  
  CONCLUSIONS
  Evaluation of the findings obtained in the present cadaveric study showed that a posterior approach to the vagus nerve is feasible. The technique for posterior exposure of the carotid sheath may prove useful in surgical exposures of the vagus nerve when a standard anterior method is not possible.
authors.affiliation: Section of Pediatric Neurosurgery, Department of Cell Biology, University of Alabama at Birmingham, and Children's Hospital Birmingham, Alabama 35233, USA. rstubbs@uab.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Marios
authors.initials: M
authors.lastname: Loukas
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.forename: E George
authors.initials: EG
authors.lastname: Salter
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004210:Dissection / Q000379:methods; D004599:Electric Stimulation Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000294:innervation* / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D014630:Vagus Nerve / Q000033:anatomy & histology* / Q000601:surgery*