Intra-operative neuromonitoring and electrophysiological nerve stimulation for the spinal accessory and marginal mandibular nerve during neck dissection: a scoping review

Evaluating the effectiveness of intra-operative nerve monitoring and stimulation in preventing spinal accessory nerve and marginal mandibular nerve injuries during neck dissection.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review methodology was used to map and summarise current literature. Online PubMed/MEDLINE searches and manual screening identified relevant studies for inclusion.

Seven studies met the inclusion criteria. Six addressed the spinal accessory nerve and one the marginal mandibular nerve. No randomised controlled trials were identified. The evidence tentatively supports the use of intra-operative neurophysiological monitoring in reducing spinal accessory nerve and marginal mandibular nerve palsy rates during neck dissection. Intra-operative neurophysiological monitoring modalities varied across studies, from continuous neuromonitoring to handheld nerve stimulation and nerve mapping. Monitoring criteria and outcome definitions differed across studies.

The evidence base for intra-operative neurophysiological monitoring of standard accessory nerve and marginal mandibular nerve during neck dissection remains methodologically heterogeneous. Standardised protocols, prospective controlled studies and dedicated marginal mandibular nerve monitoring studies are required before routine implementation can be recommended.