Morphological variability of the intercostobrachial nerve and potential surgical significance

Abstract

Background

The intercostobrachial nerve (ICBN) typically originates from the lateral cutaneous branch of the second intercostal nerve (T2). The ICBN may sometimes arise from the lateral cutaneous branch of T3. Many authors have undertaken ICBN studies as it is a highly variable structure with numerous morphological patterns reported. Variations include double-, triple-, and multiple ICBNs and their potential interconnections (ICs).

Aim

The current cadaveric study aims to explore the ICBN morphological variants, examining their origins, branching patterns, and relationships with adjacent vessels. Identifying neural variants closely correlates with arterial alterations and may reveal deviations in the ICBN typical course.

Materials and methods

Dissections were conducted on 30 (15 male and 15 female) formalin-embalmed Greek donated cadavers (60 sides in total) with an average age of 74.

Results

Forty-three out of sixty sides had typical ICBN anatomy (71.7%). ICBN variants were identified on 17/60 sides (11 unilateral [9 right and two left] and three bilateral cases) with an incidence of 28.3%. Concerning the ICBN morphology, a single ICBN existed on 9/60 sides (15%), two ICBNs (T2 and T3) on 3/60 sides (5%), three, four, and five, and multiple ICBNs on 1/60 sides (1.7%) per each. An ICBN division into two or three branches was identified on 3/60 sides (5%). ICBN interconnections (ICs) were identified with the medial brachial cutaneous nerve (MBCN) and the medial antebrachial cutaneous nerve (MACN) in 3 cases (5%) and 1 case (1.7%). ICs with the radial nerve (RN) were identified in 3 cases (5%) and ICs with both the MBCN and MACN in a unique case (1.7%). Arterial covariants were identified in 4 out of 60 cases (6.7%).

Conclusions

The current gross anatomy study emphasizes the clinical significance of preserving the ICBN during surgical procedures to prevent sensory loss or dysesthesia in the upper arm.