Morphological study of the ansa cervicalis and the phrenic nerve

Banneheka, Shyama

doi:10.1111/j.1447-073x.2007.00201.x

Cited by 60 publications

(53 citation statements)

References 14 publications

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“…lateral type, is in accordance to Banneheka and Mwachaka et al, who found this in 75% and 81.5% of cases repectively [4,5].…”

Section: Shilpi Agarwal Et Al Double Fused Y-shaped Loop Of Ansa Cesupporting

confidence: 74%

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An Unusual Finding of Double Fused YShaped Loop of Ansa Cervicalis and its Clinical Significance

Agarwal¹

2016

IJARS

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The ansa cervicalis (AC) is a neural loop formed by union of superior root derived from ventral ramus of C1 through hypoglossal nerve and inferior root derived from ventral rami of C2 and C3. The aim of this case report is to emphasize the anatomical description and surgical importance of a rare variation of AC owing to its closeness with major vessels and nerves of neck. An unusual double fused Y-shaped loop pattern of ansa cervicalis was observed on the right side of the neck of a 50 years old male cadaver in which the inferior root had separate C2 and C3 components. The C2 component joined the superior root of AC to form the Y-shaped superior loop. The stem of the superior loop joined the ventral rami of C3 root to form the inferior loop. Knowledge of variations in origin, course and pattern of distribution of ansa cervicalis is important since the branches of ansa cervicalis are often chosen for laryngeal reinnervation of the laryngeal muscles following recurrent laryngeal nerve palsy and also to avoid iatrogenic injuries during surgical procedures of the neck. CASE REPORTDuring routine dissecton as a part of undergraduate teaching schedule, we observed a double loop pattern of ansa cervicalis (AC) on the right side of the neck of a 50 years old male formalin fixed cadaver. On the left side, no such variation was found in the ansa cervicalis formation.

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“…lateral type, is in accordance to Banneheka and Mwachaka et al, who found this in 75% and 81.5% of cases repectively [4,5].…”

Section: Shilpi Agarwal Et Al Double Fused Y-shaped Loop Of Ansa Cesupporting

confidence: 74%

“…Branch to inferior belly of omohyoid arose from inferior root in the current case which was also reported by Banneheka [4].…”

Section: Shilpi Agarwal Et Al Double Fused Y-shaped Loop Of Ansa Cesupporting

confidence: 57%

An Unusual Finding of Double Fused YShaped Loop of Ansa Cervicalis and its Clinical Significance

Agarwal¹

2016

IJARS

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“…The phrenic nerve may receive additional spinal roots from one or more of the following nerves; nerve to subclavius, nerve to sternohyoid, C2 or rarely C6, descendens cervicalis; ansa cervicalis and brachial plexus or receive a branch from hypoglossal nerve and may communicate with CN XI (spinal accessory) (BANNEHEKA, 2008). The case presented here showed a bilateral asymmetry in the root of the phrenic nerve.…”

Section: Discussionmentioning

confidence: 80%

“…As far as we know absence of the fibrous pericardium has not been reported and less noticed. Interestingly such seemingly unimportant Banneheka (2008) in a cadaveric study(106 cadavers) reported in 52% of the cases the phrenic originated from C4 and C5 and only in one case C4 segment was absent.…”

Section: Discussionmentioning

confidence: 99%

Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

Ahmadpour

Foghi

2016

J Morphol Sci

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Phrenic nerve provides the major motor supply to diaphragm. Various anatomical variations in the course and distribution of the phrenic nerve have reported before. Here we report a rare bilateral asymmetric variation in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver. Specifically, the right phrenic nerve was arising from the upper trunk of the brachial plexus (C5) and the left side nerve originated from the supraclavicular nerve and a tiny branch from C5. In the same cadaver both sides phrenic nerve were buried in the mediastinal pleura. Another interesting finding was absence of the fibrous pericardium. To the best of our knowledge the presented case showed a very rare variation in the roots of origin of the phrenic nerve accompanied with pericardial anomaly which has been less reported. We think such case is of practical importance during supraclavicular block during anesthesia

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“…15 The cervical plexus (C1-4) supplies neck muscles and various skin territories and has known communications, which can explain the spinal accessory and phrenic nerve involvement. 1,22 Brachial plexus involvement could have occurred via the right phrenic nerve (C3-5) or intercommunications from C-4.…”

Section: Postoperative Coursementioning

confidence: 99%

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

Restrepo¹,

Spinner²,

Howe

et al. 2015

JNS

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P erineural spread is increasingly recognized as a relatively common mechanism of metastasis in many types of malignancies, particularly those involving the head and neck region. This mechanism of tumor spread for metastatic melanoma is well known to occur along the cranial nerves and cervical plexus. 4,9,14,[16][17][18] We describe a rare example of documented perineural spread of melanoma, arising in the mandible and extending along a cranial nerve, the cervical plexus, and into the brachial plexus. We correlate the clinicoradiological features and propose an anatomopathological explanation to support the mechanism of perineural spread in this case. case report HistoryA 48-year-old right-handed woman presented in 2010 with a several-month history of progressive numbness, tingling, itching, and atrophy affecting the skin and muscles of the right neck. MRI of the cervical spine revealed right C2-3 and C3-4 foraminal masses (Fig. 1 left). The patient underwent observation. Repeat MRI performed 7 months later showed spinal cord displacement at the level of C-2 ( Fig. 1 right). The patient underwent an open biopsy-the findings of which were consistent with a neurofibromaand 1 week later, C2-4 laminectomy, decompression, and fusion. The lesion was partially resected. Postoperatively, the patient received 45-Gy radiotherapy to a field from the top of C-2 to the bottom of C-6, including the spinal cord as well as an 18-Gy boost to the right-sided upper cervical roots and nerves. Brain MRI findings at that time were normal. The brachial plexus was not imaged.Over the next 2 years the patient had persistent cervical discomfort and progressive pain in her right shoulder and then the biceps region. Neither partial removal of the instrumentation nor steroid injections provided relief of her pain, which progressed as time passed. In 2013 she was evaluated at a tertiary care facility when she noted weakness in shoulder abduction and external rotation. Imaging now revealed plexiform lesions involving multiple cervical nerves and the upper brachial plexus. Pathological specimens were reviewed and the findings were interpreted as hybrid schwannoma/neurofibroma. The patient was thought to have a segmental form of schwannomatosis.The patient had a history of melanoma. In 2001, she had a lesion excised from her trunk with no local recurrence. In 2004, she had a nearly 2-cm lesion excised from the angle of the right jaw, a fusion of lentigo maligna and desmoplastic types. It was invasive to Clark's Level IV 5 and Breslow's 3 depth 3 mm.The mitotic rate was 0. Local perineural invasion was evident in the specimen. Tumor was present at the biopsy margins. The BRAF was wild type. Findings from the sentinel cervical lymph node biopsy were negative. Physical ExaminationIn February 2014, the patient presented to our institution. Physical examination revealed atrophic right neck Perineural spread is a well-known mechanism of dissemination of head and neck malignancies. There are few reports of melanoma involving the brachial plexus in th...

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Morphological study of the ansa cervicalis and the phrenic nerve

Cited by 60 publications

References 14 publications

An Unusual Finding of Double Fused YShaped Loop of Ansa Cervicalis and its Clinical Significance

An Unusual Finding of Double Fused YShaped Loop of Ansa Cervicalis and its Clinical Significance

Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

Perineural spread of malignant melanoma from the mandible to the brachial plexus: case report

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