RESUMEN
BACKGROUND: To the authors' knowledge, there has not been an ultrasound study of the vulnerable vessels in a C3-7 cervical nerve root block (CNRB). OBJECTIVES: To evaluate the prevalence of vulnerable vessels around the target of a CNRB at the cervical nerve root of C3-7 levels in a clinical setting. DESIGN: Retrospective, cross-sectional study. SETTING: General teaching hospital, rehabilitation unit. PARTICIPANTS: A total of 104 patients complaining of neck or arm pain with no prior surgical history and who had undergone a CNRB at an outpatient clinic from May 2015 to December 2017 were included. MAIN OUTCOME MEASUREMENTS: The prevalence of vulnerable vessels as seen on a preprocedure ultrasound scan around the target of a CNRB at the cervical nerve root of C3-7 levels. RESULTS: Out of 104 cases, the C3 level had 7 blood vessels (8.33%), the C4 level had 14 blood vessels (13.86%), the C5 level had 17 blood vessels (16.35%), the C6 level had 27 blood vessels (25.96%), and the C7 level had 31 blood vessels (29.81%) either at the targeted cervical nerve root or at the site of the imaginary needle's projected pathway to the targeted cervical nerve root. CONCLUSION: There was a substantial prevalence of vulnerable vessels either at the targeted nerve root or at the site of the needle's projected pathway to the nerve root.
Asunto(s)
Bloqueo del Plexo Cervical/métodos , Plexo Cervical/irrigación sanguínea , Vértebras Cervicales/irrigación sanguínea , Radiculopatía/terapia , Raíces Nerviosas Espinales/irrigación sanguínea , Adulto , Anciano , Plexo Cervical/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Estudios Transversales , Femenino , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor , Dimensión del Dolor , Pronóstico , Radiculopatía/diagnóstico por imagen , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Ultrasonografía/métodosRESUMEN
OBJECTIVES: The cervical part of the vagus nerve (CVN) has become an important target for stimulation therapy to treat epilepsy and psychiatric conditions. For this purpose, the CVN is visualized in the carotid sheath, assuming it to be localized dorsomedially between the carotid artery (CA) and the internal jugular vein (JV). The aim of our morphological study was therefore to revisit the CVN relationships to the CA and JV, hypothesizing it to have common variations to this classical textbook anatomy. MATERIALS AND METHODS: Positional relations of the CVN, CA and JV were investigated in the carotid sheath of 35 cadavers at the C3 to C6 level. Positional relations of the CVN, CA and JV were documented on the basis of a 3 × 3 chart. RESULTS: Eighteen different arrangements of the CVN, CA and JV were observed. The typical topographic relationship of the CVN dorsomedially between the CA and JV was only found in 42% of all cases. The CVN was located dorsally or (dorso-)laterally to the CA in 80% and dorsally or (dorso-)medially of the JV in 96% of all cases. CONCLUSIONS: Classical textbook anatomy of the CVN is only present in a minority of cases. Positional variations in contrast to textbook anatomy are considerably more frequent than previously described, which might be a hypothetical morphological explanation for the lack of efficacy or side effects of CVN stimulation. Furthermore, the position of the CVN relative to the internal jugular vein is more consistent than to the CA.
Asunto(s)
Arterias Carótidas/anatomía & histología , Plexo Cervical/anatomía & histología , Venas Yugulares/anatomía & histología , Nervio Vago/anatomía & histología , Anciano , Anciano de 80 o más Años , Plexo Cervical/irrigación sanguínea , Femenino , Humanos , Masculino , Nervio Vago/irrigación sanguíneaRESUMEN
The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.