Rare Intraoperative Finding of the Spinal Accessory Nerve Piercing a Fenestration in the Internal Jugular Vein: A Case Report and Review of the Modern Literature

Abstract

Variations in the anatomy of venous structures in the neck are not uncommon, but fenestrations are extremely unusual. Here, we report a rare case of the spinal accessory nerve piercing a fenestration in the internal jugular vein, found during elective neck dissection of a patient undergoing hemiglossectomy. Further, we present a literature review of recent previously published cases of this intraoperative finding. This paper is intended to provide readers with an appreciation for this particularly rare variation and to highlight its existence to surgeons who perform neck dissection. This knowledge is important in order to minimise the possibility of intraoperative damage.

Keywords: Anatomical variation; Fenestration; Internal jugular vein; Neck dissection; Piercing; Spinal accessory nerve.

Fig. 1

Preoperative image of the tongue, showing a squamous cell carcinoma

Fig. 2

Intraoperative image from the operating microscope, showing the spinal accessory nerve (green star) piercing the internal jugular vein (yellow star), with the clamped facial artery (blue star) also visible