Repositorio
Institucional

Iwanaga, Joe

Yang, Seanna

Olewnik, Lukasz

Konschake, Marko

Loukas, Marios

Dumont, Aaron S.

Ottone, Nicolas E.

Sanudo, Jose

Tubbs, R. Shane

The Anterolateral Cervical Atlanto-Occipital Plexus: A Novel Finding with Application to Skull Base and Spine Surgery and Pain Disorders of the Head and Neck

ELSEVIER SCIENCE INC

WORLD NEUROSURGERY

en

BACKGROUND: We have described a novel nerve plexus of the upper neck. By exploring how the individual components of this specific anterolateral nerve plexus communicate with each other, patient care could be improved regarding the preoperative diagnosis, intraoperative navigation, and minimally invasive treatment. METHODS: Using a surgical microscope, 11 adult cadaveric heads (22 cadaveric hemi-sides) were dissected. The region of the junction between the atlanto-occipital and craniocervical junctions was explored, specifically, the innervation of this region via adjacent nerve connections. Branches from these regional nerve sources were analyzed for interconnections, and, when found, these branches were documented and measured. RESULTS: A delicate nerve plexus was found overlying the anterolateral C1-C2 junction in all specimens. The plexus was contributed by the sympathetic trunk, vagus nerve, hypoglossal nerve, and C1 and C2 ventral rami. We termed this plexus the anterolateral cervical atlantooccipital (ALCAO) plexus. On all but 2 cadaveric hemisides (91%), the C2 ventral ramus provided the most input into the plexus, with 1-2 branches. On 2 cadaveric hemisides, the C1 ventral ramus was the primary contributor and, on average, this nerve contributed 1-2 branches to the plexus. For 8 cadaveric hemi-sides (36.4%), the C1 fibers that are known to travel with the hypoglossal nerve and be distributed to the geniohyoid and thyrohyoid muscles arose from C1 nerve fibers that first traversed the ALCAO plexus. The sympathetic trunk contributed 1-4 lateral branches, with most of these arising superiorly from the superior cervical ganglion. The vagus nerve contributed 1-2 lateral branches and the hypoglossal nerve contributed 1-2 anteromedial branches. This plexus was located more or less lateral to the sympathetic trunk and superior cervical ganglion and medial to the transverse process of C1 and C2. The plexus innervated the rectus capitis lateralis, rectus capitis anterior, and lateral atlanto-occipital joint and, on 4 cadaveric hemi-sides, the atlantoaxial joint. Additionally, small branches were seen traveling to the anterior atlantoaxial and anterior atlanto-occipital membranes on 55% and 77.2% of the cadaveric hemi-sides, respectively. On 6 hemi-sides, very small branches from the ALCAO plexus ended in the periosteum over the anterolateral aspect of the anterior arch and transverse process of the C1 vertebra. CONCLUSIONS: It is important to recognize that the course of these interneural connections varies and could result in unforeseen complications during surgical procedures. A comprehensive knowledge of these neural connections will be useful when considering surgery and evaluating pathology of the neck and skull base.

artículo original

10.1016/j.wneu.2021.12.008

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Anatomy

Complications

Iatrogenic

Injury

Neurosurgery

Nervous

Skull base

Spine

Surgery

ANSA CERVICALIS

HYPOGLOSSAL

ANATOMY

NERVES

COMPLEX

Neurología Clínica

Cirugía

Anatomía

Complicaciones

Iatrogénica

Lesión

Neurocirugía

Nervioso

Base del cráneo

Columna vertebral

Cirugía

ANSA CERVICALIS

HIPOGLOSSAL

ANATOMÍA

NERVIOS

COMPLEJO

Anatomía y Morfología

Neurociencias

Cirugía

The Anterolateral Cervical Atlanto-Occipital Plexus: A Novel Finding with Application to Skull Base and Spine Surgery and Pain Disorders of the Head and Neck

E84

E90

artículo original

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WOS:000820574500018