title: Role of Sonography in Surgical Decision Making for Iatrogenic Spinal Accessory Nerve Injuries: A Paradigm Shift.
abstract: The spinal accessory nerve (SAN) is susceptible to iatrogenic injury in the posterior cervical triangle. Early diagnosis and management of suspected SAN transection injuries are crucial in the restoration of shoulder stability and function. Although neurologic examination and electrodiagnostic testing can assess SAN function, they cannot assess nerve continuity. We report the use of sonography to prospectively evaluate the SAN in 6 patients with suspected iatrogenic SAN injury. Sonography directly visualized SAN transection in 4 cases, whereas sonographic findings were reported as "probable" transection in the fifth case and was nondiagnostic in the sixth case in the setting of extensive scarring.
authors.affiliation: Departments of Neurologic Surgery (A.C., R.J.S.), and Physical Medicine and Rehabilitation, Radiology, and Anatomy (J.S.), Mayo Clinic, Rochester, Minnesota USA; and Department of Anatomical Sciences, St George's University, Grenada, West Indies (A.C.).
authors.forename: Alper
authors.initials: A
authors.lastname: Cesmebasi
authors.affiliation: Departments of Neurologic Surgery (A.C., R.J.S.), and Physical Medicine and Rehabilitation, Radiology, and Anatomy (J.S.), Mayo Clinic, Rochester, Minnesota USA; and Department of Anatomical Sciences, St George's University, Grenada, West Indies (A.C.).
authors.forename: Jay
authors.initials: J
authors.lastname: Smith
authors.affiliation: Departments of Neurologic Surgery (A.C., R.J.S.), and Physical Medicine and Rehabilitation, Radiology, and Anatomy (J.S.), Mayo Clinic, Rochester, Minnesota USA; and Department of Anatomical Sciences, St George's University, Grenada, West Indies (A.C.). spinner.robert@mayo.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
mesh_terms: D061227:Accessory Nerve Injuries / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care; D011379:Prognosis; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
keywords: iatrogenic injury; neurosonology; sonography; spinal accessory nerve