Knowledge of Anatomical Relationships of the Vagus Nerve with Internal Jugular Vein and Common Carotid Artery in the Neck Necessary for Vagus Nerve St

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1 Knowledge of Anatomical Relationships of the Vagus Nerve with Internal Jugular Vein and Common Carotid Artery in the Neck Necessary for Vagus Nerve Stimulation S Surgery Sachiko Takamizawa, M.D., and Michiharu Morino, M.D. Department of Neurosurgery and Epilepsy Center, Tokyo Metropolitan Hospital A precise understanding of the anatomy is essential to perform vagus nerve stimulation S therapy for refractory epilepsy. We evaluated the anatomical relationships of the cervical vagus nerve with the carotid artery and jugular vein on the basis of findings during S surgery. We investigated the anatomical relationships among the vagus nerve, common carotid artery, and internal jugular vein in 73 patients who underwent S surgery at our hospital from December 2010 to January 2015, classified the position of the into 5 categories, and studied the frequency of each category. The position of the was medial to the and ventral to the type 1 in 8 patients 10.9, medial to the and lateral to the type 2 in 4 5.5, dorsomedial to the and ventral to the type 3 in 51 70, dorsomedial to the and lateral to the type 4 in 7 9.5, and dorsal to the type 5 in This report is the first to propose a classification of the anatomical relationships of the with the and based on intraoperative findings. According to this classification, the difficulty of S surgery increases with advances of the type. Type 3 was the most frequent, and types 2 and 5 were rare. Understanding the variation in the position of the cervical vagus nerve is considered to contribute to safer surgical manipulations in S surgery. Received April 3, 2015 accepted May 15, 2015 Key words vagus nerve stimulation S surgery, vagus nerve, internal jugular vein, common carotid artery Jpn J Neurosurg Tokyo , 2015 vagus nerve stimulation S 1997 FDA S Address reprint requests to Sachiko Takamizawa, M.D., Department of Neurosurgery, Tokyo Metropolitan Hospital, Musashidai, Fuchu shi, Tokyo , Japan Jpn J Neurosurg VOL. 24 NO

2 S S S S S 5 S S 3 /carotid endarterectomy CEA S CEA CEA 30 mm / internal jugular vein / common carotid artery S N S

nerve relative to the left common carotid artery and left internal jugular vein seen from

Yellow circle, blue circle, red circle A Type 1 Medial to the and ventral to.

3 A Ventral Cranial Lateral B C Fig. 1 Variation in the anatomical position of the vagus nerve The position of the left vagus nerve relative to the left common carotid artery and left internal jugular vein seen from below are shown as schemes and intraoperative photographs. Yellow circle, blue circle, red circle A Type 1 Medial to the and ventral to. B Type 2 Medial to the and lateral to the. C Type 3 Dorsomedial to the and ventral to the. D Type 4 Dorsomedial to the and lateral to the. E Type 5 Dorsal to the. Jpn J Neurosurg VOL. 24 NO

D E Fig. 1 cont d ないと考えた当院において 2010 年 12 月 2015 年 1 Type 4 内背側で外側 Fig.

1E 行った 73 例を対象とし手術ビデオを再検討することにより迷走神経との解剖学的位置からタイプ結を分類し

経の位置を以下の 5 つのタイプに分類した 34 例であった平均年齢は 29 歳 1 67 歳で 16 歳 Type 1 内側で腹側 Fig.

4 D E Fig. 1 cont d ないと考えた当院において 2010 年 12 月 2015 年 1 Type 4 内背側で外側 Fig. 1D 月の期間に主術者あるいは主術者の指導下に S を Type 5 背側 Fig. 1E 行った 73 例を対象とし手術ビデオを再検討することにより迷走神経との解剖学的位置からタイプ結を分類しさらにそれぞれのタイプが手術難易度にどのような影響があったのかを後方視的に考察した迷走神果 S を初回施行された 73 例の内訳は男 39 例女経の位置を以下の 5 つのタイプに分類した 34 例であった平均年齢は 29 歳 1 67 歳で 16 歳 Type 1 内側で腹側 Fig. 1A 未満の小児は 12 例含まれた平均身長は 153 cm 80 Type 2 内側で外側 Fig. 1B 189 cm 平均体重は 54 kg kg 平均 BMI は Type 3 内背側で腹側 Fig. 1C 22 であった 708 脳外誌 24 巻 10 号 2015 年 10 月

5 S Type Type Type Type Type Type 1 0 0Type 2 0 0Type Type Type Type 1 34 Type 2 25 Type 3 28 Type 4 29 Type 5 25 BMI Type 1 22 kg m 2 Type 2 21 kg m 2 Type 3 21 kg m 2 Type 4 21 kg m 2 Type 5 23 kg m 2 Type 1 96 Type 2 91 Type 3 97 Type Type Type Type 4 5 p 0.06 S S S / / 2 Type 1 Type 2 Type 1 Type 1 Type 3 Type 2 Type 4 Type 3 Type 3 Type 5 Type 3 Type 4 Type 3 70 Type 2 Type 5 5 Type Type 3 Type 3 Type 3 Type 4 5 Type Type Type 4 5 Type 4 5 Type Jpn J Neurosurg VOL. 24 NO

6 Troianos 7 1,009 Type Type 1,3,4,5 219 Shoja Turba Type Type S 29 Ha Park Type 5 Tubbs 8 1 Type Type S S

7 S S COI COI Ha EJ, Baek JH, Lee JH, Kim JK, Shong YK Clinical significance of vagus nerve variation in radiofrequency ablation of thyroid nodules. Eur Radiol , Park JK, Jeong SY, Lee JH, Lim GC, Chang JW Variations in the course of the cervical vagus nerve on thyroid ultrasonography. AJNR Am J Neuroradiol , Shoja MM, Ardalan MR, Tubbs RS, Loukas M, Vahedinia S, Jabbary R, Jalilvand M, Shakeri A The relationship between the internal jugular vein and common carotid artery in the carotid sheath the effects of age, gender and side. Ann Anat , Sulek CA, Gravenstein N, Blackshear RH, Weiss L Head rotation during internal jugular vein cannulation and the risk of carotid artery puncture. Anesth Analg , Troianos CA, Kuwik RJ, Pasqual JR, Lim AJ, Odasso DP Internal jugular vein and carotid artery anatomic relation as determined by ultrasonography. Anesthesiology , Tubbs RS, Loukas M, Shoja MM, Blevins D, Humphrey R, Chua GD, Kelly DR, Oakes WJ An unreported variation of the cervical vagus nerve anatomical and histological observations. Folia Morphol Warsz , Turba UC, Uflacker R, Hannegan C, Selby JB Anatomic relationship of the internal jugular vein and the common carotid artery applied to percutaneous transjugular procedures. Cardiovasc Intervent Radiol , Type 1 Type 2 Type 3 Type 4 Type 5 Type 3 Type 1 5 S Jpn J Neurosurg VOL. 24 NO

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