title: Ultrasound visualization of the spinal accessory nerve in vivo.
abstract: BACKGROUND
  Inadvertent injury of the spinal accessory nerve during surgical procedures is a cause of significant morbidity with medicolegal repercussions. Surface anatomy is an unreliable guide to the nerve's location. We suggest that ultrasound can be used to map the course of the nerve in the posterior triangle of the neck.
  
  
  METHODS
  Fifty healthy subjects (28 females, mean age 37 y) were scanned using a VF13-5 linear probe and a Siemens Sonoline Antares ultrasound machine (Siemens Medical Solutions USA Inc., Malvern, PA). The caliber, course, and distribution of the nerve in the posterior triangle of the neck were recorded.
  
  
  RESULTS
  The nerve was visualized bilaterally in all subjects, running superficially across the posterior triangle with either a straight (56%) or tortuous (44%) course at a depth of about 3 mm beneath the skin surface. It had a mean caliber of 0.76 ± 0.12 mm. It exited the posterior border of sternocleidomastoid at a mean of 6.7 (4.0-9.4) cm below the mastoid process and 1.1 (0.1-2.1) cm above the great auricular point and penetrated the anterior border of trapezius 5.4 (2.1-9.2) cm above the clavicle. Importantly, 58% of nerves divided into 2-4 branches before penetrating trapezius; the nerve branched on at least one side in 49 of 50 individuals.
  
  
  CONCLUSIONS
  The spinal accessory nerve and its anatomical variants can be consistently and reliably demonstrated by ultrasound in normal individuals. Surface anatomical landmarks are not a reliable guide to the position and course of the nerve in the posterior triangle. Preoperative mapping of the nerve with ultrasound may reduce the risk of iatrogenic injury.
authors.affiliation: Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand.
authors.forename: Seyed A
authors.initials: SA
authors.lastname: Mirjalili
authors.forename: Jill C
authors.initials: JC
authors.lastname: Muirhead
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stringer
mesh_terms: D000055:Accessory Nerve / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult