同: CN XI, 副神経

WordNet

clothing that is worn or carried, but not part of your main clothing (同)accoutrement, accouterment
a supplementary component that improves capability (同)appurtenance, supplement, add-on
furnishing added support; "an ancillary pump"; "an adjuvant discipline to forms of mysticism"; "The mind and emotions are auxiliary to each other" (同)adjunct, ancillary, adjuvant, appurtenant, auxiliary
someone who helps another person commit a crime (同)accessary
any bundle of nerve fibers running to various organs and tissues of the body (同)nervus
control of your emotions; "this kind of tension is not good for my nerves"

PrepTutorEJDIC

=accessory
《通例複数形で》(…への)『付属品』,アクセサリー《+『for』+『名』》 / (法律用語で)従犯者,犯人隠匿(いんとく)者 / 付属の / 従犯の
〈C〉『神経』 / 〈C〉《複数形で》『神経過敏』,いらだち / 〈U〉『勇気』,度胸(courage) / 〈U〉《時にa ~》厚かましさ,ずぶとさ;無礼 / 〈C〉葉脈;(昆虫の)翅脈(しみゃく) / 〈人,特に自分〉‘に'力を与える,‘を'元気づける

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/24 20:43:41」(JST)

wiki en

The accessory nerve is a cranial nerve that controls the sternocleidomastoid and trapezius muscles. As part of it was formerly believed to originate in the brain, it is considered the eleventh of twelve cranial nerves, or simply cranial nerve XI.

Traditional descriptions of the accessory nerve divide it into two parts: a spinal part and a cranial part.^[1] However, because the cranial component rapidly joins the vagus nerve, becoming an integral part of said nerve, modern descriptions often consider the cranial component to be part of the vagus nerve and not part of the accessory nerve proper.^[2] For this reason, in contemporary discussions of the accessory nerve, the common practice is to dismiss the cranial part altogether, referring to the accessory nerve specifically as the spinal accessory nerve.

The spinal accessory nerve provides motor innervation from the central nervous system to two muscles of the neck: the sternocleidomastoid muscle and the trapezius muscle. The sternocleidomastoid muscle tilts and rotates the head, while the trapezius muscle has several actions on the scapula, including shoulder elevation and abduction of the arm.

Range of motion and strength testing of the neck and shoulders can be measured during a neurological examination to assess function of the spinal accessory nerve. Limited range of motion or poor muscle strength are suggestive of damage to the spinal accessory nerve, which can result from a variety of causes. Injury to the spinal accessory nerve is most commonly caused by medical procedures that involve the head and neck.^[3] Clinically, iatrogenic injury usually results in severe wasting and loss of volume of the trapeizus muscle which is, typically, very noticeable.

The accessory nerve is derived from the basal plate of the embryonic spinal segments C1–C6.

Structure

Upon exiting the skull via the jugular foramen, the spinal accessory nerve pierces the sternocleidomastoid muscle before terminating on the trapezius muscle.

Like other cranial nerves, the spinal accessory nerve exits the cranium through a specialized hole (or foramen). However, unlike all other cranial nerves, the spinal accessory nerve begins outside the skull rather than inside. In particular, in the majority of individuals, the fibers of the spinal accessory nerve originate solely in neurons situated in the upper spinal cord.^[4] These fibers coalesce to form spinal rootlets, roots, and finally the spinal accessory nerve itself, which enters the skull through the foramen magnum, the large opening at the base of the skull. The nerve courses along the inner wall of the skull towards the jugular foramen, through which it exits the skull with the glossopharyngeal (CN IX) and vagus nerves (CN X). Owing to its peculiar course, the spinal accessory nerve is notable for being the only cranial nerve to both enter and exit the skull.

Traditionally, the accessory nerve is described as having a small cranial component that descends from the medulla oblongata and briefly connects with the spinal accessory component before branching off of the nerve to join the vagus nerve. A recent study of twelve subjects suggests that in the majority of individuals, this cranial component does not make any distinct connection to the spinal component; the roots of these distinct components were separated by a fibrous sheath in all but one subject.^[4]

Once the cranial component has detached from the spinal component, the spinal accessory nerve continues alone and heads posteriorly (backwards) and inferiorly (downwards) upon exiting the skull through the jugular foramen. In the neck, the accessory nerve crosses the internal jugular vein around the level of the posterior belly of digastric muscle. Masoud Saman et al. in a study of 84 necks^[5] reported that in the anterior triangle of the neck the accessory nerve crossed the internal jugular vein anteriorly in 80% of necks, posteriorly in 19% and in the one case of internal jugular vein bifurcation, the nerve pierced the vein. The average distance traveled by nerve from base of skull to crossing the internal jugular vein was 2.38 cm. As it courses caudally, the nerve pierces the sternocleidomastoid muscle while sending it motor branches, then continues inferiorly until it reaches the trapezius muscle to provide motor innervation to its upper portion.

Nucleus

The fibers that form the spinal accessory nerve are formed by lower motor neurons located in the upper segments of the spinal cord. This cluster of neurons, called the spinal accessory nucleus, is located in the posterolateral aspect of the anterior horn of the spinal cord. This is in contrast to most other motor neurons, whose cell bodies are found in the spinal cord's anterior horn. The lateral horn of high cervical segments appears to be continuous with the nucleus ambiguus of the medulla oblongata, from which the cranial component of the accessory nerve is derived.

Function

The accessory nerve provides Special visceral efferent (SVE) innervation, functioning in motor control of the sternocleidomastoid and trapezius muscles, both of brachial lineage.

Clinical relevance

Muscles innervated by the accessory nerve

Injury

Injury to the spinal accessory nerve can cause an accessory nerve disorder or spinal accessory nerve palsy, which results in diminished or absent function of the sternocleidomastoid muscle and upper portion of the trapezius muscle.

The distal part of the spinal accessory nerve is most susceptible to injury. Throughout much of its course, the nerve is protected from injury by the muscles it innervates. It is in the interval between protection from these muscles, which corresponds to the distal part of the nerve, that the spinal accessory nerve is most vulnerable to injury.

Examination

As physical examination cannot directly assess the functioning of nerves, assessment of spinal accessory nerve function is usually done indirectly. This is often accomplished through gross observation, range of motion testing, and strength testing, with specific attention to the trapezius and sternocleidomastoid muscles which are innervated by the spinal accessory nerve.

The trapezius muscle is tested by asking the patient to shrug their shoulders with and without resistance. A one-sided weakness is indicative of an injury to the spinal accessory nerve on the same side (termed ipsilateral) of the body being assessed. The sternocleidomastoid muscle is tested by asking the patient to turn their head to the left or right against resistance. Weakness in head-turning suggests injury to the contralateral spinal accessory nerve: a weak leftward turn is indicative of a weak right sternocleidomastoid muscle (and thus right spinal accessory nerve injury), while a weak rightward turn is indicative of a weak left sternocleidomastoid muscle (and thus left spinal accessory nerve).

Gross observation may identify other findings associated with spinal accessory nerve injury. Patients with spinal accessory nerve palsy may exhibit signs of lower motor neuron disease such as diminished muscle mass (atrophy) and fasciculations of the sternocleidomastoid and trapezius muscles.

History

In 1848, Jones Quain described the nerve as the "spinal nerve accessory to the vagus", recognizing that while a minor component of the nerve joins with the larger vagus nerve, the majority of accessory nerve fibers originate in the spinal cord.^[6] Quain also suggested spinal accessory nerve as a shortened form of the term; this term, and its more abbreviated variant, accessory nerve, have persisted to modern times. Throughout this interval, the nerve has never had a consistent name among investigators and medical practitioners. Some use accessory nerve and spinal accessory nerve interchangeably; others distinguish between spinal accessory nerve and cranial accessory nerve; still others use accessory nerve to refer to both spinal and cranial components of the nerve.

In Neuroanatomy and the Neurologic Exam, Terence R. Anthoney provides a historical account of the usage of the terms accessory nerve, spinal accessory nerve, and cranial accessory nerve, summarized in the following excerpt:

To summarize, then, the eleventh cranial nerve was called both the "accessory nerve" and the "spinal accessory nerve" as early as 1848—"accessory" referring to its fibers which became accessory to the vagus nerve and "spinal" referring to its largely spinal origin. When it became recognized, as early as 1893, that the "accessory" fibers to the vagus nerve came from the same medullary nuclei as the rest of the vagal efferent fibers, people began to view the "accessory" fibers as part of the vagus nerve proper, leaving the eleventh cranial nerve to originate solely from its spinal nucleus. This shift was reinforced by the neuroclinicians, who could only test the integrity of the spinal portion of the nerve separately anyway. Because of the shift to just a spinal origin for the nerve, the word "accessory" came to be associated with the "true"—i.e., spinal—component of the nerve, no longer being considered in the context of "accessory to the vagus." This association has been reinforced by referring to the spinal nucleus of origin as the "(spinal) accessory nucleus."^[7]

Classification

Among investigators there is disagreement regarding the terminology used to describe the type of information carried by the accessory nerve. As the trapezius and sternocleidomastoid muscles are derived from the branchial arches, some investigators believe the spinal accessory nerve that innervates them must carry branchiomeric (special visceral efferent, SVE) information.^[8] This is in line with the observation that the spinal accessory nucleus appears to be continuous with the nucleus ambiguus of the medulla. Others, notably Haines, consider the spinal accessory nerve to carry general somatic efferent (GSE) information.^[9] Still others believe it is reasonable to conclude that the spinal accessory nerve contains both SVE and GSE components.^[10]

Additional images

Dura mater and its processes exposed by removing part of the right half of the skull, and the brain.
Hind- and mid-brains; postero-lateral view.
The nerves of the scalp, face, and side of neck.
Upper part of medulla spinalis and hind- and mid-brains; posterior aspect, exposed in situ.
Course and distribution of the glossopharyngeal, vagus, and accessory nerves.
Plan of the cervical plexus.
Side of neck, showing chief surface markings.
Spinal cord. Brachial plexus. Cerebrum, inferior view, deep dissection.

References

^ "The Accessory Nerve". Gray's Anatomy of the Human Body.
^ "Spinal Accessory Nerve". Structure of the Human body, Loyola University Medical Education Network. Archived from the original on 16 June 2007. Retrieved 2007-06-17.
^ London J, London NJ, Kay SP (1996). "Iatrogenic accessory nerve injury". Annals of the Royal College of Surgeons of England 78 (2): 146–50. PMC 2502542. PMID 8678450.
^ ^a ^b Ryan S, Blyth P, Duggan N, Wild M, Al-Ali S (2007). "Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen". Anatomical science international / Japanese Association of Anatomists 82 (1): 1–7. doi:10.1111/j.1447-073X.2006.00154.x. PMID 17370444.
^ Saman M, Etebari P, Pakdaman MN, Urken ML (2010). "Anatomic relationship between the spinal accessory nerve and the jugular vein: a cadaveric study". Surgical and Radiologic Anatomy 33 (2): 175–179. doi:10.1007/s00276-010-0737-y. PMID 20959982.
^ Jones Quain (1848). Richard Quain, William Sharpey, ed. Elements of Anatomy 2 (5th ed.). London: Taylor, Walton, and Maberly. p. 812.
^ Terence R. Anthoney (1993). Neuroanatomy and the Neurologic Exam: A Thesaurus of Synonyms, Similar-Sounding Non-Synonyms, and Terms of Variable Meanings. Boca Raton: CRC-Press. pp. 69–73. ISBN 0-8493-8631-4.
^ William T. Mosenthal (1995). A Textbook of Neuroanatomy: With Atlas and Dissection Guide. Washington, DC: Taylor & Francis. p. 12. ISBN 1-85070-587-9.
^ Duane E. Haines (2004). Neuroanatomy: an atlas of structures, sections, and systems. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4677-9.
^ Joshi SS, Joshi SD (2001). "Muscle Dorso-Fascialis — A Case Report". Journal of the Anatomical Society of India 50 (2): 159–160.

External links

MedEd at Loyola GrossAnatomy/h_n/cn/cn1/cn11.htm
lesson6 at The Anatomy Lesson by Wesley Norman (Georgetown University)
cranialnerves at The Anatomy Lesson by Wesley Norman (Georgetown University) (XI)
Anatomy photo:28:13-0115 at the SUNY Downstate Medical Center
Cranial Nerves at Yale 11-1

Notes on Accessory Nerve

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 上肢末梢神経症候群の概要 overview of upper extremity peripheral nerve syndromes
2. 頭頸部皮膚切除における解剖学的危険部位 anatomic danger zones in cutaneous surgery of the head and neck
3. 肘および手首の尺骨神経障害 ulnar neuropathy at the elbow and wrist
4. 腕神経叢症候群 brachial plexus syndromes
5. 眼の待機手術に対する麻酔 anesthesia for elective eye surgery

English Journal

Anatomic study of the intercostal nerve transfer to the suprascapular nerve and a case report.

Hu S, Chu B, Song J, Chen L.Author information Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.AbstractThe purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with intercostal nerves in brachial plexus root avulsions. We found that the 3rd and 4th intercostal nerves could be transferred to the suprascapular nerve without a nerve graft. Based on the anatomical study, the 3rd and 4th intercostal nerves were transferred to the suprascapular nerve via the deltopectoral approach in a 42-year-old man who had had C5-7 root avulsions and partial injury of C8, T1 of the right brachial plexus. Thirty-two months postoperatively, the patient gained 30° of shoulder abduction and 45° of external rotation. This procedure provided us with a reliable and convenient method for shoulder function reconstruction after brachial plexus root avulsion accompanied with spinal accessory nerve injury. It can also be used when the accessory nerve is intact but needs to be preserved for better shoulder stability or possible future trapezius transfer.
The Journal of hand surgery, European volume.J Hand Surg Eur Vol.2014 Feb;39(2):194-8. doi: 10.1177/1753193413475963. Epub 2013 Feb 6.
The purpose of this study was to investigate the anatomical basis of intercostal nerve transfer to the suprascapular nerve and provide a case report. Thoracic walls of 30 embalmed human cadavers were used to investigate the anatomical feasibility for neurotization of the suprascapular nerve with int
PMID 23390150

Transverse cervical and great auricular nerve distribution in the mandibular area: A study in human cadavers.

Ella B, Langbour N, Caix P, Midy D, Deliac P, Burbaud P.Author information Laboratoire d'Anatomie, Zone Sud, Université Bordeaux2, Bordeaux Cedex, France.AbstractThe angle of the jaw is innervated by the auricular branch of the superficial cervical plexus (SCP). Cervical cutaneous nerves of the CP carry the sensation from the antero-lateral cervical skin. It is clinically relevant to identify the cervical cutaneous nerve distribution and the nerve point using superficial landmarks but published studies describing the emerging patterns and cervical cutaneous nerve branch distributions in the mandible are rare. The overlap between the cervical and trigeminal and facial nerve distributions and anastomoses is highly variable. The objective of this study was to characterize the distribution of the SCP nerves in the different parts of the mandible. Two hundred and fifty fresh and formalin-fixed human cadaver heads were microdissected to observe the distribution of the transverse cervical (TCN) and great auricular (GAN) nerves. Two main groups (G1 and G2) based on the emergence of the TCN and GAN behind the posterior edge of the sternocleidomastoid muscle and three types (T1, T2, and T3) based on their distribution in the different mandibular parts were observed. Statistical analysis showed that parameters related to the mandibular side (P = 0.307), gender (P = 0.218), and group (P = 0.111) did not influence the facial distribution of these nerves. The only parameter influencing the distribution was the type of nerve (GAN and TCN) (P < 0.001). In the face, the SCP reached the mandible in 97% of cases, its distribution and extent were subject-dependent. These results confirmed that the SCP could supply accessory innervation to the mandible through the TCN. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
Clinical anatomy (New York, N.Y.).Clin Anat.2014 Jan 17. doi: 10.1002/ca.22369. [Epub ahead of print]
The angle of the jaw is innervated by the auricular branch of the superficial cervical plexus (SCP). Cervical cutaneous nerves of the CP carry the sensation from the antero-lateral cervical skin. It is clinically relevant to identify the cervical cutaneous nerve distribution and the nerve point usin
PMID 24442996

Spinal to accessory nerve transfer in traumatic brachial plexus palsy: is body mass index a predictor of outcome?

Socolovsky M, Di Masi G, Bonilla G, Malessy M.Author information Nerve & Plexus Surgery Program, Division of Neurosurgery, University of Buenos Aires School of Medicine, La Pampa 1175 Torre 2 5A, Buenos Aires, 1428, Argentina, socolovsky@fibertel.com.ar.AbstractINTRODUCTION: Several factors that affect functional recovery after surgery in severe brachial plexus lesions have been identified, i.e., time to surgery and presence of root avulsions. The body mass index (BMI) of the patient could be one of these possible factors. The objective of the present paper is to systematically study the relationship between BMI and the outcome of abduction following spinal accessory to suprascapular nerve transfer.
Acta neurochirurgica.Acta Neurochir (Wien).2014 Jan;156(1):159-63. doi: 10.1007/s00701-013-1896-5. Epub 2013 Oct 22.
INTRODUCTION: Several factors that affect functional recovery after surgery in severe brachial plexus lesions have been identified, i.e., time to surgery and presence of root avulsions. The body mass index (BMI) of the patient could be one of these possible factors. The objective of the present pape
PMID 24146182

Japanese Journal

片側性特発性舌下神経麻痺の1例

森一将,藤原敬子,嶋田淳
日本口腔診断学会雑誌 28(1), 44-47, 2015
… Paralysis of the hypoglossal nerve is known as a condition often observed with extracranial lesions (e.g. surgical and accidental trauma, extracranial tumors, and cervical inflammation), and intracranial diseases (e.g. cerebrovascular conditions, demyelinating diseases and brain inflammation). … Hypoglossal nerve is often involved in combination with the glossopharyngeal, vagal, and accessory nerves; …
NAID 130005075361

多発脳神経障害をきたした耳下腺上皮筋上皮癌例

鈴木久美子,佐藤慎太郎,門司幹男 [他],倉富勇一郎
耳鼻咽喉科臨床 108(4), 301-305, 2015
… We report herein on a patient with EMC arising from the deep lobe of the parotid gland who presented with facial nerve paralysis as an initial symptom, and then developed otalgia and glossopharyngeal pain, and finally presented multiple cranial nerve disorders.A 76-year-old woman was referred to us because of right otalgia lasting for 2 years and abnormal lesions in her mastoid cavity seen on magnetic resonance imaging (MRI). …
NAID 130005061542

頸部郭清術後早期の肩関節リハビリテーションの有用性

春日井滋,渡辺昭司,赤澤吉弘 [他],深澤雅彦,三上公志,齋藤善光,阿久津征利,肥塚泉
耳鼻咽喉科臨床 108(3), 229-235, 2015
… Several studies have demonstrated that spinal accessory nerve (SAN) damage causes deterioration of the QOL, and rehabilitation of the shoulder is very important in the recovery process after such surgical procedures. …
NAID 130004827517

Related Pictures

★リンクテーブル★

リンク元	「副神経」「eleventh cranial nerve」「cranial nerve XI」「nervus accessorius」
関連記事	「accessory」「nerve」

「副神経」

Accessory nerve
	Diagram of the upper portions of the glossopharyngeal, vagus, and accessory nerves.
	Inferior view of the human brain, with the cranial nerves labelled.
Details
Latin	nervus accessorius
Innervates	sternocleidomastoid muscle, trapezius muscle
Identifiers
Gray's	p.913
MeSH	A08.800.800.120.060
TA	A14.2.01.184
FMA	6720
	Anatomical terms of neuroanatomy

　　[★]

英: accessory nerve, CN XI
ラ: nervus accessorius
同: 第11脳神経 eleventh cranial nerve
関: 脳神経

一般感覚性

臓性感覚性

特殊感覚性

体性運動性

臓性運動性

鰓弓運動性

神経細胞(中枢神経外)

神経細胞(中脳)

神経細胞(橋)

神経細胞(延髄)

神経細胞(脊髄)

○-＜節後ニューロン

頭蓋からの出口

分布と機能

延髄根

○

○

頚静脈孔

支配筋：軟口蓋、咽頭の横紋筋、喉頭（いずれも脳神経Xに加わる神経を経由）~

脊髄根

○(疑核)

○

頚静脈孔

支配筋：胸鎖乳突筋と僧帽筋~

脳神経＞:脳神経

「eleventh cranial nerve」

　　[★]

第XI脳神経、第11脳神経、第十一脳神経

関: accessory nerve、cranial nerve XI、spinal accessory nerve

「cranial nerve XI」

　　[★]

第XI脳神経

関: accessory nerve、eleventh cranial nerve、spinal accessory nerve

「nervus accessorius」

　　[★]

副神経

関: accessory nerve、spinal accessory nerve

「accessory」

　　[★]

adj.

付属の、アクセサリーの、副

n.

付属物

関: adjunct、adjunctive、appendage

「nerve」

　　[★]

n.

神経

関: nervi、nervous、nervus、neural、neuro、neuron

[1] "The Accessory Nerve". Gray's Anatomy of the Human Body.

[luc-2] "Spinal Accessory Nerve". Structure of the Human body, Loyola University Medical Education Network. Archived from the original on 16 June 2007. Retrieved 2007-06-17.

[london-3] London J, London NJ, Kay SP (1996). "Iatrogenic accessory nerve injury". Annals of the Royal College of Surgeons of England 78 (2): 146–50. PMC 2502542. PMID 8678450.

[ryan-4] Ryan S, Blyth P, Duggan N, Wild M, Al-Ali S (2007). "Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen". Anatomical science international / Japanese Association of Anatomists 82 (1): 1–7. doi:10.1111/j.1447-073X.2006.00154.x. PMID 17370444.

[saman-5] Saman M, Etebari P, Pakdaman MN, Urken ML (2010). "Anatomic relationship between the spinal accessory nerve and the jugular vein: a cadaveric study". Surgical and Radiologic Anatomy 33 (2): 175–179. doi:10.1007/s00276-010-0737-y. PMID 20959982.

[6] Jones Quain (1848). Richard Quain, William Sharpey, ed. Elements of Anatomy 2 (5th ed.). London: Taylor, Walton, and Maberly. p. 812.

[anthoney-7] Terence R. Anthoney (1993). Neuroanatomy and the Neurologic Exam: A Thesaurus of Synonyms, Similar-Sounding Non-Synonyms, and Terms of Variable Meanings. Boca Raton: CRC-Press. pp. 69–73. ISBN 0-8493-8631-4.

[8] William T. Mosenthal (1995). A Textbook of Neuroanatomy: With Atlas and Dissection Guide. Washington, DC: Taylor & Francis. p. 12. ISBN 1-85070-587-9.

[9] Duane E. Haines (2004). Neuroanatomy: an atlas of structures, sections, and systems. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4677-9.

[10] Joshi SS, Joshi SD (2001). "Muscle Dorso-Fascialis — A Case Report". Journal of the Anatomical Society of India 50 (2): 159–160.

匿名

検索

案内

案内

accessory nerve