Is the cranial accessory nerve really a portion of the accessory nerve? Anatomy of the cranial nerves in the jugular foramen

  • Shaun Ryan
  • Phil Blyth
  • Nick Duggan
  • Martin Wild
  • Saad Al-Ali
Original article

Abstract

The accessory nerve is traditionally described as having both spinal and cranial roots, with the spinal root originating from the upper cervical segments of the spinal cord and the cranial root originating from the dorsolateral surface of the medulla oblongata. The spinal rootlets and cranial rootlets converge either before entering the jugular foramen or within it. In a recent report, this conventional view has been challenged by finding no cranial contribution to the accessory nerve. The present study was undertaken to re-examine the accessory and vagus nerves within the cranium and jugular foramen, with particular emphasis on the components of the accessory nerve. These nerves were traced from their rootlets attaching to the spinal cord and the medulla and then through the jugular foramen. The jugular foramen was exposed by removing the dural covering and surrounding bone. A surgical dissecting microscope was used to trace the roots of the glossopharyngeal nerve (CN IX), vagus nerve (CN X) and accessory nerve (CN XI) before they entered the jugular foramen and during their travel through it. The present study demonstrates that the accessory nerve exists in two forms within the cranial cavity. In the majority of cases (11 of 12), CN XI originated from the spinal cord with no distinct contribution from the medulla. However, in one of 12 cases, a small but distinct connection was seen between the vagus and the spinal accessory nerves within the jugular foramen.

Key words

accessory nerve human jugular foramen vagus nerve 

References

  1. Arey LB (1965) Developmental Anatomy. A Textbook and Laboratory Manual of Embryology. WB Saunders, Philadelphia.Google Scholar
  2. Arnold F (1838) Icones Nervorum Capitis. Sumtibus Auctoris, Heildelberg.Google Scholar
  3. Ayeni SA, Ohata K, Tanaka K, Hakuba A (1995) The microsurgical anatomy of the jugular foramen. J Neurosurg 83, 903–9.PubMedCrossRefGoogle Scholar
  4. Bergman RA, Afifi AK (2004) Illustrated Encyclopedia of Human Anatomic Variation (online). http://www.vh.org/adult/provider/anatomy/AnatomicVariants/AnatomyHP.htmlGoogle Scholar
  5. Berry M, Bannister L, Standring S (1995) Nervous system. In: Gray’s Anatomy, 38th edn. Churchill Livingstone, London, 1225–58.Google Scholar
  6. Bieger D, Hopkins DA (1987) Viscerotopic representation of the upper alimentary tract in the medulla oblongata in the rat: The nucleus ambiguus. J Comp Neurol 262, 546–62.PubMedCrossRefGoogle Scholar
  7. Brodal A (1981) Neurological Anatomy, 3rd edn. Oxford University Press, New York, 457–470.Google Scholar
  8. Brown H, Hidden G, Ledroux M, Poitevan L (2000) Anatomy and blood supply of the lower four cranial and cervical nerves: Relevance to surgical neck dissection. Proc Soc Exp Biol Med 223, 352–61.PubMedCrossRefGoogle Scholar
  9. Butler AB, Hodos W (2005) Comparative Vertebrate Neuroanatomy. Evolution and Adaptation. Wiley-Liss, New York.Google Scholar
  10. Caliot P, Bousquet V, Midy D, Cabanie P (1989) A contribution to study of the accessory nerve: Surgical implications. Surg Radiol Anat 11, 11–15.PubMedCrossRefGoogle Scholar
  11. Chase MR, Ranson SW (1914) The structure of the roots, trunk and branches of the vagus nerve. J Comp Neurol 24, 31–60.CrossRefGoogle Scholar
  12. Gardiner KJ, Irvine BW, Murray A (2002) Anomalous relationship of the spinal accessory nerve to the internal jugular vein. Clin Anat 15, 62–3.PubMedCrossRefGoogle Scholar
  13. Goldenberg RA, Gardner (1991) Tumors of the jugular foramen: Surgical preservation of neural function. Otolarngol Head Neck Surg 104, 129.Google Scholar
  14. Hollinshead WH (1982) Anatomy for Surgeons, 3rd edn, Vol. 1. Lippincott Williams & Wilkins, Philadelphia.Google Scholar
  15. Ibrahim T, Tuccar E, Aslan A et al. (1998) The jugular foramen a comparative radio anatomic study. Surg Neurol 50, 557–62.CrossRefGoogle Scholar
  16. Kandel ER, Schwartz JH, Jessell TM (2000) Principles of Neural Science, 4th edn. McGraw-Hill, New York.Google Scholar
  17. Katsuta T, Rhoton AL, Matsushima T (1997) The jugular foramen: Microsurgical anatomy and operative approaches. Neurosurgery 41, 149–201.PubMedCrossRefGoogle Scholar
  18. Kitamura S, Okubo J, Ogatu K, Sakai A (1987) Fibers supplying the laryngeal musculature in the cranial root of the rabbit accessory nerve: Nucleus of origin, peripheral course and innervated muscles. Exp Neurol 97, 592–606.PubMedCrossRefGoogle Scholar
  19. Kitamura S, Nishiguchi T, Ogatu K, Sakai A (1989) Neurons of origin of the internal ramus of the rabbit accessory nerve: Localization in the dorsal nucleus of the vagus nerve and the nucleus retroambigularis. Anat Rec 224, 541–9.PubMedCrossRefGoogle Scholar
  20. Krause HR, Bremerich A, Herrmann M (1991) The innervation of the trapezius muscle in connection with radical neck dissection: An anatomical study. J Craniomaxillofac Surg 12, 87–9.Google Scholar
  21. Lachman N, Acland R, Rosse C (2002) Anatomical evidence for the absence of a morphologically distinct cranial root in the accessory nerve of man. Clin Anat 15, 4–10.PubMedCrossRefGoogle Scholar
  22. Nishiguchi T, Kitamura S, Okubo J, Ogata K, Sakai A (1986) Location of the rabbit spinal accessory nucleus: A study by means of the HRP method. J Osaka Univ School 26, 51–8.Google Scholar
  23. O’Rahilly R, Muller F (1984) The early development of hypoglossal nerve and occipital somites in staged human embryos. Am J Anat 169, 237–57.PubMedCrossRefGoogle Scholar
  24. Ramina R, Maniglia J, Fernandes Y, Paschoal J, Pfeilsticker L, Neto M (2005) Tumors of the jugular foramen: Diagnosis and management. Neurosurg Online 57 (Suppl. 1), 59–68.Google Scholar
  25. Rhoton AL (2000) Jugular foramen: The posterior cranial fossa: Microsurgical anatomy and surgical approaches. Neurosurg Online 47 (Suppl. 3), S267–85.Google Scholar
  26. Romanes GJ (1979) Cunningham’s Textbook of Anatomy, 11th edn. Oxford University Press, London.Google Scholar
  27. Sachs E, Valtin EW (1977) Bischoff: Microscopic Analysis of the Anastomoses Between the Cranial Nerves. University Press of New England, New Hampshire.Google Scholar
  28. Soo KC, Hamlyn PJ, Pegington J, Westbury G (1986) Anatomy of the accessory nerve and its cervical contributions in the neck. Head Neck Surg 9, 111–15.PubMedCrossRefGoogle Scholar
  29. Soo KC, Guiloff RJ, Oh A, Querici G, Westbury G (1990) Innervation of trapezius muscle: A study in patient undergoing neck dissection. Head Neck Surg 12, 488–95.CrossRefGoogle Scholar
  30. Stacey RJ, O’Leary ST, Hamlyn PJ (1996) An anomaly in the nerve supply of the trapezius muscle. Clin Anat 9, 414- 16.PubMedCrossRefGoogle Scholar
  31. Standring S (2005) Head and neck. In: Gray’s Anatomy, 39th edn. Elsevier Churchill Livingstone, Edinburgh, 555–8.Google Scholar
  32. Wild JM, Johnston BM, Gluckman PD (1991) Central projections of the nodose ganglion and the origin of vagal efferents in the lamb. J Anat 175, 105–29.PubMedGoogle Scholar

Copyright information

© Japanese Association of Anatomists 2006

Authors and Affiliations

  • Shaun Ryan
    • 1
  • Phil Blyth
    • 1
  • Nick Duggan
    • 1
  • Martin Wild
    • 1
  • Saad Al-Ali
    • 1
  1. 1.Department of Anatomy with RadiologyFaculty of Medical and Health Sciences, University of AucklandAucklandNew Zealand

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