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Avoidance of scapular winging while approaching tumors of the middle scalene region

  • Ross C. PufferEmail author
  • Jonathan Stone
  • Robert J. Spinner
Original Article - Neurosurgical Anatomy
  • 18 Downloads
Part of the following topical collections:
  1. Neurosurgical anatomy

Abstract

Background

Large tumors arising from the middle scalene region can displace the middle scalene muscle and distort regional anatomy, placing nerves at risk. Understanding the surgical anatomy of these nerves is key to approaching pathology of the middle scalene muscle and avoiding damage to the dorsal scapular, long thoracic, and spinal accessory nerves, each of which can cause scapular winging and associated morbidity if injured.

Methods

IRB approval was obtained for this study, allowing cases with relevant pathology to be reviewed and presented to highlight the relevant surgical technique. Anatomical depictions were created to correlate intraoperative images with known anatomical relationships.

Results

Key to this approach is consideration of the regional anatomy in a standard supraclavicular approach, the superficial plane, containing the anterior scalene muscle and brachial plexus, and the oblique plane containing the middle scalene muscle, long thoracic, spinal accessory, and dorsal scapular nerves. Identification and mobilization of each of these structures prior to lesion removal can not only provide likely boundaries of the tumor, but also allow for protection of the nerves to avoid injury that may lead to scapular winging with associated morbidity and functional impairment of the upper extremity.

Conclusions

Lesions of the middle scalene region often split two important anatomical planes, the superficial and deep, creating an advantageous surgical corridor through an anterolateral approach. Through early identification of known anatomy, these two planes can be developed, and a safe approach to the lesion of the middle scalene region can be exploited.

Keywords

Scapular Winging Brachial Plexus Approach Technique 

Notes

Compliance with ethical standards

The authors have been compliant with all applicable ethical standards in the publication of this manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

IRB approval was obtained for this study. All patients included signed consent forms for the use of non-identifying medical information in medical research, including this study. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryMayo ClinicRochesterUSA

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