Accessory nerve monitoring and stimulation during neck surgery

Abstract

Iatrogenic injury to the spinal accessory nerve following surgical procdures in the neck is well recognized in causing significant morbidity to patients, with shoulder pain and loss of function being particularly problematic. We have used a Magstim Neurosign 100 peripheral nerve monitor, that is most often used in our practice to monitor the facial nerve during middle ear and parotid surgery, to monitor the accessory nerve during neck surgery. Ten patients undergoing accessory nerve-sparing neck dissection, or excision biopsy of neck mass had their accessory nerve monitored during the procedure. No patient suffered injury of the nerve. In several cases the nerve closely adhered to the tissue being resected, and in two cases, the nerve bifurcated or gave off branches. We found that the monitor aided identification and preservation of the nerve.

Neck treatment and shoulder morbidity: Still a challenge

“…The use of spinal accessory nerve monitoring has been suggested to not only aid with identification of the nerve itself, but may aid in minimizing trauma and preserving nerve function postoperatively 67. However, another study on nerve monitoring concluded that electrophysiological integrity of the spinal accessory nerve was not completely predictive of clinical outcomes 68…”

Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

“…Unintentional stretching of the nerve may occur even with soft retractors [494]. Good experiences with nerve monitoring in 10 patients were reported by Midwinter [495], who confirmed earlier findings of Harpf [482]. To date, nerve monitoring of the spinal accessory nerve is not widely accepted as it is for cranial base surgery, parotid gland surgery or thyroid surge [427].…”

Intraoperative cranial nerve monitoring

“…7,58,85 Again, no controlled data are available to confirm that these monitoring procedures reduce the risk of lower cranial nerve injury during head and neck surgery.…”