Contralateral spinal accessory nerve for ipsilateral neurotization of branches of the brachial plexus: a cadaveric feasibility study.

Abstract

Additional nerve transfer options are important to the peripheral nerve surgeon to maximize patient outcomes following nerve injuries. Potential regional donors may also be injured or involved in the primary disease. Therefore, potential contralateral donor nerves would be desirable. To the authors' knowledge, use of the contralateral spinal accessory nerve (SAN) has not been explored for ipsilateral neurotization procedures. In the current study, therefore, the authors aimed to evaluate the SAN as a potential donor nerve for contralateral nerve injuries by using a novel technique. In 10 cadavers, the SAN was harvested using a posterior approach, and tunneled subcutaneously to the contralateral side for neurotization to various branches of the brachial plexus. Measurements were made of the SAN available for transfer and of its diameter. The authors found an SAN length of approximately 20 cm (from transition of upper and middle fibers of the trapezius muscle to approximately 2-4 cm superior to the insertion of the trapezius muscle onto the spinous process of T-12) available for nerve transposition. The average diameter was 2.5 mm. Based on these findings, the contralateral SAN may be considered for ipsilateral neurotization to the suprascapular and axillary nerves.