title: Spinal accessory neuropathy following dual tunneling of lead extensions for motor cortex stimulation.
abstract: BACKGROUND
  Spinal accessory nerve (SAN) injury is a known complication of surgery involving the posterior cervical triangle. Because the nerve lies in a plane that is traversed by extension leads for neuromodulation, the SAN is at risk during tunneling for these procedures.
  
  
  METHODS
  We report a 50-year-old man who developed spinal accessory neuropathy after tunneling of two sets of extension leads through his neck to connect to the pulse generator at the chest wall. Immediately postoperatively, he developed severe right shoulder pain and trapezius weakness manifested as decreased shoulder abduction and scapular winging.
  
  
  RESULTS
  Electromyography 2 months later confirmed a SAN injury. Ultrasonography demonstrated the SAN to be angulated between the two sets of extension leads in the posterior cervical triangle. Operative exploration confirmed this finding. Neurolysis was performed and the deep extension lead was relocated superficial to the nerve. Postoperatively, the patient had immediate resolution of his shoulder pain and an improved range of motion.
  
  
  CONCLUSIONS
  As the indications for neuromodulation continue to grow, tunneling may be performed more frequently. It is our belief that the second pass through the neck of a dual extension lead system may inadvertently be directed deeply and poses an increased risk to the SAN.
authors.affiliation: Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Lipinski
authors.forename: Jamie
authors.initials: J
authors.lastname: Van Gompel
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
mesh_terms: D061227:Accessory Nerve Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation*; D004576:Electromyography / Q000379:methods; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D014463:Ultrasonography