Origin and prevalence of the accessory phrenic nerve: A meta-analysis and clinical appraisal

The accessory phrenic nerve (APN) is a common anatomical variant with differing reports of prevalence in the literature. It can be injured during operative procedures to the neck and thorax or by regional anesthetic techniques in its vicinity. Our aim was to provide a comprehensive evidence-based assessment of the prevalence and origins of the APN. The databases PubMed, China National Knowledge Infrastructure, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science were searched comprehensively, followed by assessment of eligibility and extraction of data concerning the APN. The data were pooled into a meta-analysis. A total of 17 studies were included in the meta-analysis. Fourteen studies (n=1,941 hemi-necks) reported data on APN prevalence resulting in an overall pooled prevalence estimate of 36.5%. Nine studies (n=941 APNs) reported data on the origin of the APN. Most commonly the APN originated from the ansa cervicalis (16.5%) followed by the nerve to the subclavius (15.8%). Subgroup analysis on the basis of laterality and geographic region revealed no statistically significant findings. The APN is a highly variable anatomical structure present in over one third of the population, most often originating from the ansa cervicalis or the nerve to the subclavius. Clinicians need to be aware of the varying constellation of symptoms that can arise from APN injury. Ultimately, knowledge of APN variation could provide for better outcomes and reduction of iatrogenic injuries, particularly in high-risk patients prone to long-term complications from diaphragmatic dysfunction. Clin. Anat. 30:1077-1082, 2017. (c) 2017 Wiley Periodicals, Inc.