{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T08:56:19Z","timestamp":1779180979886,"version":"3.51.4"},"reference-count":9,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"OBJECTIVE<\/jats:title>The accessory nerve is frequently repaired or used for nerve transfer. The length of accessory nerve available is often insufficient or marginal (under tension) for allowing direct coaptation during nerve repair or nerve transfer (neurotization), necessitating an interpositional graft. An attractive maneuver would facilitate lengthening of the accessory nerve for direct coaptation. The aim of the present study was to identify an anatomical method for such lengthening.<\/jats:p><\/jats:sec>METHODS<\/jats:title>In 20 adult cadavers, the C-2 or C-3 connections to the accessory nerve were identified medial to the sternocleidomastoid (SCM) muscle and the anatomy of the accessory nerve\/cervical nerve fibers within the SCM was documented. The cervical nerve connections were cut. Lengths of the accessory nerve were measured. Samples of the cut C-2 and C-3 nerves were examined using immunohistochemistry.<\/jats:p><\/jats:sec>RESULTS<\/jats:title>The anatomy and adjacent neural connections within the SCM are complicated. However, after the accessory nerve was \u201cdetethered\u201d from within the SCM and following transection, the additional length of the accessory nerve increased from a mean of 6 cm to a mean of 10.5 cm (increase of 4.5 cm) after cutting the C-2 connections, and from a mean of 6 cm to a mean length of 9 cm (increase of 3.5 cm) after cutting the C-3 connections. The additional length of accessory nerve even allowed direct repair of an infraclavicular target (i.e., the proximal musculocutaneous nerve). The cervical nerve connections were shown not to contain motor fibers.<\/jats:p><\/jats:sec>CONCLUSIONS<\/jats:title>An additional length of the accessory nerve made available in the posterior cervical triangle can facilitate direct repair or neurotization procedures, thus eliminating the need for an interpositional nerve graft, decreasing the time\/distance for regeneration and potentially improving clinical outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2016.10.jns161106","type":"journal-article","created":{"date-parts":[[2017,3,3]],"date-time":"2017-03-03T14:59:15Z","timestamp":1488553155000},"page":"272-276","source":"Crossref","is-referenced-by-count":3,"title":["A novel method of lengthening the accessory nerve for direct coaptation during nerve repair and nerve transfer procedures"],"prefix":"10.3171","volume":"128","author":[{"given":"R. Shane","family":"Tubbs","sequence":"first","affiliation":[{"name":"Seattle Science Foundation;"},{"name":"Department of Anatomical Sciences, St. George's University, Grenada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9s A.","family":"Maldonado","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yolanda","family":"Stoves","sequence":"additional","affiliation":[{"name":"Department of Pathology, Children's of Alabama, Birmingham, Alabama; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian N.","family":"Fries","sequence":"additional","affiliation":[{"name":"Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology, Children's of Alabama, Birmingham, Alabama; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marios","family":"Loukas","sequence":"additional","affiliation":[{"name":"Department of Anatomical Sciences, St. George's University, Grenada;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rod J.","family":"Oskouian","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, Washington;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Spinner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns161106","series-title":"Clin Plast Surg","first-page":"133","article-title":"Paralysis in root avulsion of the brachial plexus. Neurotization by the spinal accessory nerve","volume":"11","author":"Allieu Y,","year":"1984","unstructured":"Allieu Y, Privat JM, Bonnel F: Paralysis in root avulsion of the brachial plexus. Neurotization by the spinal accessory nerve. Clin Plast Surg 11:133\u2013136, 19846705460"},{"key":"b2-jns161106","series-title":"Clin Anat","first-page":"761","article-title":"An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: How to avoid and treat it","volume":"28","author":"Cesmebasi A,","year":"2015","unstructured":"Cesmebasi A, Spinner RJ: An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: How to avoid and treat it. Clin Anat 28:761\u2013766, 2015"},{"key":"b3-jns161106","series-title":"J Histotechnol","first-page":"80","article-title":"Preservation of acetylcholinesterase enzyme activity in non-frozen rectal biopsy specimens for Hirschsprung disease","volume":"35","author":"Chua AC,","year":"2012","unstructured":"Chua AC, Chua GD, Kelly DR: Preservation of acetylcholinesterase enzyme activity in non-frozen rectal biopsy specimens for Hirschsprung disease. J Histotechnol 35:80\u201388, 2012"},{"key":"b4-jns161106","series-title":"Clin Anat","first-page":"1167","article-title":"Morphological characteristics of the cranial root of the accessory nerve","volume":"27","author":"Liu HF,","year":"2014","unstructured":"Liu HF, Won HS, Chung IH, Kim IB, Han SH: Morphological characteristics of the cranial root of the accessory nerve. Clin Anat 27:1167\u20131173, 201425131313"},{"key":"b5-jns161106","series-title":"Clin Anat","first-page":"97","article-title":"Variable composition of the internal and external branches of the accessory nerve","volume":"27","author":"Liu HF,","year":"2014","unstructured":"Liu HF, Won HS, Chung IH, Oh CS, Kim IB: Variable composition of the internal and external branches of the accessory nerve. Clin Anat 27:97\u2013101, 201424254966"},{"key":"b6-jns161106","series-title":"Clin Anat","first-page":"467","article-title":"Expanding what is known of the anatomy of the spinal accessory nerve","volume":"28","author":"Restrepo CE,","year":"2015","unstructured":"Restrepo CE, Tubbs RS, Spinner RJ: Expanding what is known of the anatomy of the spinal accessory nerve. Clin Anat 28:467\u2013471, 201525546396"},{"key":"b7-jns161106","series-title":"Clin Anat","first-page":"102","article-title":"Cranial roots of the accessory nerve exist in the majority of adult humans","volume":"27","author":"Tubbs RS,","year":"2014","unstructured":"Tubbs RS, Benninger B, Loukas M, Cohen-Gadol AA: Cranial roots of the accessory nerve exist in the majority of adult humans. Clin Anat 27:102\u2013107, 201422855423"},{"key":"b8-jns161106","series-title":"Clin Anat","first-page":"899","article-title":"An anatomic study of the spinal accessory nerve: extended harvest permits direct nerve transfer to distal plexus targets","volume":"20","author":"Vathana T,","year":"2007","unstructured":"Vathana T, Larsen M, de Ruiter GCW, Bishop AT, Spinner RJ, Shin AY: An anatomic study of the spinal accessory nerve: extended harvest permits direct nerve transfer to distal plexus targets. Clin Anat 20:899\u2013904, 200717879303"},{"key":"b9-jns161106","series-title":"Plast Reconstr Surg","first-page":"104","article-title":"Full-length phrenic nerve transfer by means of video-assisted thoracic surgery in treating brachial plexus avulsion injury","volume":"110","author":"Xu WD,","year":"2002","unstructured":"Xu WD, Gu YD, Xu JG, Tan LJ: Full-length phrenic nerve transfer by means of video-assisted thoracic surgery in treating brachial plexus avulsion injury. 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