Preoperative percutaneous cranial nerve mapping in head and neck surgery

Area of Science:

• Neurosurgery
• Surgical Navigation
• Anatomy

Background:

• Accurate identification of peripheral cranial nerve branches is crucial for safe head and neck and facial plastic surgery.
• Preoperative planning often relies on anatomical knowledge, which may not fully account for individual variations.
• Minimizing nerve damage during surgery is essential to prevent functional deficits.

Purpose of the Study:

• To introduce and evaluate a novel method for preoperative percutaneous mapping of peripheral cranial nerve branches.
• To assess the feasibility and accuracy of this technique in identifying nerve locations prior to surgical intervention.

Main Methods:

• A prospective study involving 142 patients undergoing head and neck or facial plastic surgery.
• Preoperative percutaneous nerve mapping was performed using a monopolar probe for stimulation and intramuscular bipolar electrodes for electromyographic recording.
• Nerve monitoring equipment was utilized under deep sedation or general anesthesia without muscle paralysis.

Main Results:

• The mandibular division was mapped in 142 patients with a 81% success rate (115/142).
• The frontal division was mapped in 60 patients with a 82% success rate (49/60).
• The accessory and hypoglossal nerves were mapped in fewer cases with varying success rates.

Conclusions:

• Preoperative percutaneous nerve mapping is an effective new method for locating peripheral cranial nerve branches.
• This technique aids surgeons in optimizing incision placement and dissection strategies, thereby enhancing surgical safety.
• Nerve mapping allows for precise avoidance of neural structures, reducing the need for extensive unmapped surgical fields.