Spinal Accessory Nerve Neural Mapping Reduces Shoulder Syndrome in Neck Dissection

Robert L. Witt ； Marisa Srivareerat

《International Journal of Head and Neck Science》 2卷3期 (2018/09) Pp. 118-123

https://doi.org/10.6696/IJHNS.201809_2(3).0004

摘要

Background: Neural mapping of the spinal accessory nerve, that includes mapping the course of the spinal accessory nerve, with precise initial neural-stimulation to locate the nerve prior to its actual intra-operative visual identification, when added to continuous intra-operative monitoring throughout the neck dissection, can reduce the incidence of shoulder syndrome compared to continuous neural monitoring without initial neural mapping. Methods: Retrospective study over 54 months of 80 consecutive patients undergoing 90 neck dissections that underwent initial neural mapping of the spinal accessory nerve and continuous neural monitoring of the nerve, in a single surgeon, single institution study. Patients were examined for scapular position, shoulder shrug, and shoulder range of motion. This was compared to a series by the same author where continuous neural monitoring was used without initial neural mapping. Results: Initial spinal accessory nerve neural mapping resulted in an overall significant reduction of shoulder syndrome from 18% (4/22) without neural mapping, to 4% (4/90) with neural mapping (p ＜ 0.05). Shoulder syndrome with neural mapping occurred in 4/36 (11.1%) patients with modified radical neck dissection (levels 1-5); 0/33 (0%) patients with selective neck dissection (levels 1-3 or 2-4) and 0/21 (0%) patients with compartmental neck dissection (levels 2-6). Conclusions: Initial neural mapping of the course of the spinal accessory nerve when added to continuous intra-operative monitoring during neck dissection can reduce the incidence of shoulder syndrome compared to continuous monitoring without initial neural mapping.

關鍵字

nerve monitoring ； spinal accessory nerve ； neural mapping ； shoulder syndrome