Osvaldo Suarez used the term spinal accessory maneuver to refer to the surgical step in which the fibrofatty tissue surrounding the spinal accessory nerve in the upper jugular region is passed beneath the nerve to be removed in-continuity with the rest of the specimen (Fig. 5-18).
After the spinal accessory nerve has been completely isolated on its course from the sternocleidomastoid muscle to the internal jugular vein, the tissue lying posterior and superior to the nerve is dissected from the splenius capitis and levator scapulae muscles (Fig. 5-18A). Once dissected from the plane of the deep muscles, the tissue is passed underneath the nerve to be removed en bloc with the rest of the specimen (Fig. 5-18B).
At this moment, two more hints may help the forthcoming dissection.
1. The tissue that has been passed beneath the nerve should also be freed from the uppermost part of the internal jugular vein (Figs. 5-18B and 5-19). This facilitates the dissection of the carotid sheath in a later step of the operation.
2. After the spinal accessory maneuver has been completed, the dissection is continued anterior to the sternocleidomastoid muscle in a downward direction for a few more centimeters. Keeping the sternocleidomastoid muscle retracted posteriorly, a number 10 knife blade is used to cut the tissue located below the entrance of spinal accessory nerve, until the underlying levator scapulae muscle is noted (Figs. 5-19 and 5-20). This cut is taken inferiorly to the level of Erb's point, and helps in the dissection of the deep muscles that will be performed in a later step of the operation.
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