Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Sedlmaier, Anke; Steinmüller, Thomas; Hermanns, Mechthild; Nawka, Tadeus; Weikert, Sebastian; Sedlmaier, B.; Caffier, Philipp P.

doi:10.1111/coa.13446

Cited by 20 publications

(19 citation statements)

References 25 publications

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“…Interpretation and effectiveness of C‐IONM depend on the surgeon's receptiveness to the electromyographic real‐time feedback obtained. However, when used and reacted appropriately, C‐IONM can likely prevent slowly evolving nerve injuries 8,38,40,51,52,67–71 . Sudden nerve injuries, such as those resulting from transection, clamping, ligation, or cautery, are less likely to result in graded partial EMG changes and generally occur too quickly to be prevented by any form of IONM.…”

Section: Resultsmentioning

confidence: 99%

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

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Background Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I‐IONM) and continuous IONM (C‐IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I‐IONM/C‐IONM and to clarify and standardize their reporting outcomes. Methods Expert review consensus statement utilizing modified Delphi methodology. Results I‐IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C‐IONM provides real‐time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. Conclusions I‐IONM and C‐IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.

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Section: Resultsmentioning

confidence: 99%

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

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“…We recommend the combined use of the HFS and IONM in equine thyroidectomy, as it helps in detection of the RLN before its visual inspection, even in anatomically distorted regions; assesses the neurophysiological integrity of the RLN; makes the procedures safe; predicts the post‐operative RLN function (Dralle et al., 2013); and diminishes post‐operative complications. Future studies should evaluate the use of continuous intraoperative neuromonitoring in horses, although continuous intraoperative neuromonitoring has been reported to be superior to I‐IONM in human patients (Jonas & Boskovic, 2014; Sedlmaier et al., 2019; Yu et al., 2019).…”

Section: Discussionmentioning

confidence: 99%

Thyroidectomy facilitated with Harmonic Caliper and intraoperative neural monitoring in three horses

Naem

Litzke

Mourad

2022

Equine Veterinary Education

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Summary Background Thyroidectomy in horses is performed conventionally; however, both iatrogenic and post‐operative complications occur, mostly due to injury of the recurrent laryngeal nerve (RLN). Objective To facilitate sufficient understanding of the use of the Harmonic Focus® Shear (HFS) together with intraoperative neuromonitoring (IONM) of the RLN during thyroidectomy in horses. Study design Retrospective case series. Methods Three horses were presented with a thyroid mass, and a hemithyroidectomy was performed using the HFS together with IONM. Medical records were reviewed. Findings at short‐term follow‐up at 6 weeks after surgery and long‐term follow‐up obtained from the referring veterinarian or owner 3 years after surgery were evaluated. Results The horses were 9–17 years old. Thyroid enlargement was unilateral in all horses, with two on the left side and one on the right side. Histological findings were consistent with adenocarcinoma, C‐cell adenocarcinoma and adenoma in each horse. Neither intraoperative‐ nor post‐operative complications were encountered. Short‐ and long‐term follow‐up showed that all horses returned to previous activity. Main limitations The limitation of this study is the small sample size, reflecting the low prevalence of this disease and the rarity of this procedure in horses. Conclusions The use of the HFS and IONM enabled an easy, precise dissection, adequate haemostasis and direct visualisation of the RLN during thyroidectomy, avoiding its damage and allowing evaluation of its function intraoperatively.

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“…A decrease in the amplitude and/or an increase in the latency of the electromyographic signal detected by the surface electrodes of the endotracheal tube on the vocal folds is an early sign of nerve trauma. This early "warning" during CIONM may enable the surgeon to avoid further, irreversible injury to the nerve by modifying the surgical maneuvers (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Preoperative ultrasound mapping of the vagus nerve in thyroid surgery

Bidault¹,

Girard²,

Attard³

et al. 2022

Gland Surg

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Background: Intraoperative neuromonitoring (IONM) in thyroid surgery requires electric stimulation of the vagus nerve to verify correct electrode placement. Classically the nerve is found deep to or in-between the common carotid artery and internal jugular vein, but previous studies have shown that the nerve can sometimes be found superficial to the vessels. Our aim was to determine the incidence of a superficial vagus nerve using ultrasound (US) and study possible clinical factors associated with an anteriorly-located vagus nerve.Methods: Retrospective study of patients undergoing thyroid surgery (lobectomy or total thyroidectomy) with intermittent IONM. Substernal goiters, locally invasive tumors or bulky lymph nodes were excluded.The vagus nerve was identified at the level of the mid-thyroid lobe on each side on preoperative US performed by two specialized radiologists, and its location according to 6 possible positions in relationship to the common carotid artery was recorded. The anatomic variability of the vagus nerve was analyzed in relationship to patient demographics and thyroid pathology.Results: Five-hundred twenty-seven patients were included. The right vagus nerve (n=522) was in-between, superficial or deep to the vessels in 92.3%, 6.1% and 1.5% and of cases, respectively, and the left vagus (n=517) in 80.2%, 18.6% and 1.2% of cases, respectively, with a statistically significant difference between right and left vagus nerves (P<0.001). The type of pathology, size of the dominant nodule or the volume of the thyroid lobe were not correlated to finding a superficial vagus nerve. Conclusions:The vagus nerve was identified in all cases on US and found to be anterior to common carotid artery at the level of the thyroid lobe in 18.6% of cases on the left and 6.1% of cases on the right.Identifying this anatomic variant preoperatively may facilitate IONM and avoid inadvertent trauma to the vagus nerve during thyroid surgery.

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Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Cited by 20 publications

References 25 publications

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Thyroidectomy facilitated with Harmonic Caliper and intraoperative neural monitoring in three horses

Preoperative ultrasound mapping of the vagus nerve in thyroid surgery

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