Accessory Nerve Disruption Following Core-Needle Biopsy: A Review of Iatrogenic Accessory Nerve Injuries and an Illustrative Case

Alexander S. Fabiano; Mark N. Pernik; Matthew MacAllister; Russell Payne

doi:10.1016/j.wneu.2022.02.091

Accessory Nerve Disruption Following Core-Needle Biopsy: A Review of Iatrogenic Accessory Nerve Injuries and an Illustrative Case

Alexander S. Fabiano, Mark N. Pernik, Matthew MacAllister, Russell Payne

Research output: Contribution to journal › Review article › peer-review

Abstract

Iatrogenic spinal accessory neve (SAN) injury is a rare complication. It most commonly occurs after open lymph node biopsies. Needle biopsy is thought to present lower risk to the SAN. However, we describe a case of a 66-year-old man who underwent core needle biopsy for lymphadenopathy and subsequently experienced ipsilateral shoulder weakness and pain. Physical examination revealed shoulder depression, lateral scapular winging, and decreased range of motion. Subsequent studies and magnetic resonance imaging demonstrated complete paralysis and denervation of SAN muscles. The nonfunctional SAN was repaired by sural nerve grafting 3 months after the injury. The patient demonstrated improved shoulder strength, range of motion, and decreased pain at 6-month follow-up. SAN injuries can be challenging to diagnose and require prompt surgical intervention. This case represents an unusual case of complete SAN disruption and palsy after core needle biopsy treated with sural nerve grafting. We review the literature on iatrogenic SAN injuries, diagnostic strategies, options for SAN surgical repair, and outcomes. SAN injuries can be challenging to diagnose but are amenable to prompt surgical options based on the mechanism and type of SAN injury.

Original language	English (US)
Pages (from-to)	156-161
Number of pages	6
Journal	World neurosurgery
Volume	161
DOIs	https://doi.org/10.1016/j.wneu.2022.02.091
State	Published - May 2022
Externally published	Yes

Keywords

Accessory nerve
Iatrogenic
Needle biopsy
Nerve disruption
Nerve graft

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1016/j.wneu.2022.02.091

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title = "Accessory Nerve Disruption Following Core-Needle Biopsy: A Review of Iatrogenic Accessory Nerve Injuries and an Illustrative Case",

abstract = "Iatrogenic spinal accessory neve (SAN) injury is a rare complication. It most commonly occurs after open lymph node biopsies. Needle biopsy is thought to present lower risk to the SAN. However, we describe a case of a 66-year-old man who underwent core needle biopsy for lymphadenopathy and subsequently experienced ipsilateral shoulder weakness and pain. Physical examination revealed shoulder depression, lateral scapular winging, and decreased range of motion. Subsequent studies and magnetic resonance imaging demonstrated complete paralysis and denervation of SAN muscles. The nonfunctional SAN was repaired by sural nerve grafting 3 months after the injury. The patient demonstrated improved shoulder strength, range of motion, and decreased pain at 6-month follow-up. SAN injuries can be challenging to diagnose and require prompt surgical intervention. This case represents an unusual case of complete SAN disruption and palsy after core needle biopsy treated with sural nerve grafting. We review the literature on iatrogenic SAN injuries, diagnostic strategies, options for SAN surgical repair, and outcomes. SAN injuries can be challenging to diagnose but are amenable to prompt surgical options based on the mechanism and type of SAN injury.",

keywords = "Accessory nerve, Iatrogenic, Needle biopsy, Nerve disruption, Nerve graft",

author = "Fabiano, {Alexander S.} and Pernik, {Mark N.} and Matthew MacAllister and Russell Payne",

note = "Funding Information: Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: {\textcopyright} 2022 Elsevier Inc.",

year = "2022",

month = may,

doi = "10.1016/j.wneu.2022.02.091",

language = "English (US)",

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AU - Fabiano, Alexander S.

AU - Pernik, Mark N.

AU - MacAllister, Matthew

AU - Payne, Russell

N1 - Funding Information: Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: © 2022 Elsevier Inc.

PY - 2022/5

Y1 - 2022/5

N2 - Iatrogenic spinal accessory neve (SAN) injury is a rare complication. It most commonly occurs after open lymph node biopsies. Needle biopsy is thought to present lower risk to the SAN. However, we describe a case of a 66-year-old man who underwent core needle biopsy for lymphadenopathy and subsequently experienced ipsilateral shoulder weakness and pain. Physical examination revealed shoulder depression, lateral scapular winging, and decreased range of motion. Subsequent studies and magnetic resonance imaging demonstrated complete paralysis and denervation of SAN muscles. The nonfunctional SAN was repaired by sural nerve grafting 3 months after the injury. The patient demonstrated improved shoulder strength, range of motion, and decreased pain at 6-month follow-up. SAN injuries can be challenging to diagnose and require prompt surgical intervention. This case represents an unusual case of complete SAN disruption and palsy after core needle biopsy treated with sural nerve grafting. We review the literature on iatrogenic SAN injuries, diagnostic strategies, options for SAN surgical repair, and outcomes. SAN injuries can be challenging to diagnose but are amenable to prompt surgical options based on the mechanism and type of SAN injury.

AB - Iatrogenic spinal accessory neve (SAN) injury is a rare complication. It most commonly occurs after open lymph node biopsies. Needle biopsy is thought to present lower risk to the SAN. However, we describe a case of a 66-year-old man who underwent core needle biopsy for lymphadenopathy and subsequently experienced ipsilateral shoulder weakness and pain. Physical examination revealed shoulder depression, lateral scapular winging, and decreased range of motion. Subsequent studies and magnetic resonance imaging demonstrated complete paralysis and denervation of SAN muscles. The nonfunctional SAN was repaired by sural nerve grafting 3 months after the injury. The patient demonstrated improved shoulder strength, range of motion, and decreased pain at 6-month follow-up. SAN injuries can be challenging to diagnose and require prompt surgical intervention. This case represents an unusual case of complete SAN disruption and palsy after core needle biopsy treated with sural nerve grafting. We review the literature on iatrogenic SAN injuries, diagnostic strategies, options for SAN surgical repair, and outcomes. SAN injuries can be challenging to diagnose but are amenable to prompt surgical options based on the mechanism and type of SAN injury.

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KW - Iatrogenic

KW - Needle biopsy

KW - Nerve disruption

KW - Nerve graft

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Accessory Nerve Disruption Following Core-Needle Biopsy: A Review of Iatrogenic Accessory Nerve Injuries and an Illustrative Case

Abstract

Keywords

ASJC Scopus subject areas

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