International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal

Schneider, Rick; Randolph, Gregory W.; Dionigi, Gianlorenzo; Wu, Che‐Wei; Barczyński, Marcin; Al-Quaryshi, Zaid; Angelos, Peter; Brauckhoff, Katrin; Cernea, Cláudio Roberto; Chaplin, John M.; Cheetham, Jonathan; Davies, Louise; Goretzki, P. E.; Hartl, Dana M.; Kamani, Dipti; Kandil, Emad; Kyriazidis, Natalia; Liddy, Whitney; Orloff, Lisa A.; Scharpf, Joseph; Serpell, Jonathan W.; Shin, Jennifer J.; Sinclair, Catherine F.; Singer, Michael C.; Snyder, Samuel K.; Tolley, Neil; Slycke, Sam Van; Volpi, Erivelto; Witterick, Ian J.; Wong, Richard J.; Woodson, Gayle E.; Zafereo, Mark; Dralle, Henning

doi:10.1002/lary.27359

Cited by 180 publications

(313 citation statements)

References 142 publications

(228 reference statements)

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“…In the literature, the positive predictive value (PPV) of intraoperative nerve monitoring is reported to range from 12% to 88% . The correlation between EMG amplitudes and vocal cord contractility, as demonstrated in this study, should be expected to result in high PPVs.…”

Section: Discussionsupporting

confidence: 53%

“…Definitions of clinically important signal changes in C‐IONM vary in the literature . The INMSG defines an impending adverse EMG as an amplitude decrease above 50% from initial baseline combined with latency increase of ≥10% . Furthermore, C‐IONM can provide the prediction of postoperative vocal cord function after intraoperative recovery of LOS.…”

Section: Discussionmentioning

confidence: 99%

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Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

et al. 2019

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Objective Gradual impairment of nerve conduction is expected to be tightly associated with simultaneous gradual loss of vocal cord contractility, related to the fact that injured axons are connected to a defined number of muscle cells. In clinical studies, there is a time gap between observed adverse electromyographic (EMG) changes and examination of vocal cord function. This study evaluates the impact of intraoperative EMG changes on synchronous vocal cord contractility by simultaneous use of continuous intraoperative neuromonitoring (C‐IONM) and accelerometry for registration of actual vocal cord function at a given change of EMG amplitude. Methods EMG was obtained following vagus nerve stimulation by use of C‐IONM. A vocal cord accelerometer probe that could be attached to the vocal cords was developed based on a LIS3DH ultra low‐power high performance three axis linear accelerometer (STMicroelectronics, Geneva, Switzerland). Accelerometer data were registered continuously together with EMG data during traction injury of the recurrent laryngeal nerve (RLN) until an amplitude depression ≤100 μV. Results Six RLN from four immature domestic pigs were studied. Vocal cord contractility assessed by vocal cord accelerometry decreased in parallel with EMG amplitude, with significant correlations ranging from 0.707 to 0.968. Conclusion Decrease of EMG amplitude during traction injury to the RLN injury is closely associated with a parallel drop in vocal cord contractility. Level of Evidence NA Laryngoscope, 130:1090–1096, 2020

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

et al. 2019

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“…Despite the possibly more ubiquitous use demonstrated in our North American cohort, our data suggests a general similarity in these attitudes between North American and non‐North American surgeons. This information, when taken in context with recent consensus guideline, also indicates that several learning opportunities exist with regard to the utility of vagal stimulation, overall safety of neural stimulation (that continued neural stimulation does not lead to loss of signal), and incorporation of loss of signal into the surgical strategy of a planned total thyroidectomy …”

Section: Discussionmentioning

confidence: 86%

“…The ATA Surgical Affairs Committee Consensus Statement on Outpatient Thyroid Surgery and the ATA Statement on Optimal Surgical Management of Goiter notes neural monitoring has a role in confirming intact neural function at the end of surgery, especially if the loss of signal is bilateral . Recently, the INMSG has published two new guidelines regarding neural monitoring . The first guideline recommends strong consideration toward staging planned contralateral lobe surgery in the setting of ipsilateral loss of electromyography (EMG) signal.…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

et al. 2019

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Objective To investigate intraoperative nerve monitoring (IONM) use among thyroid surgeons. Methods A 25‐question survey was used to assess attitudes regarding IONM use. Surveys were sent to surgeons registered to the American Academy of Otolaryngology–Head and Neck Surgery, International Association of Endocrine Surgeons, and American Head and Neck Society. Results Among 1,015 respondents, 83% reported using IONM (65.1% always using IONM and 18.1% reporting selective use). For selective users, a majority reported using IONM for reoperative cases (95.1%) and in cases with preoperative vocal cord paralysis (59.8%). When comparing location, there was a significant difference in IONM implementation (P < 0.001), with 70.4% of North American responders using it ubiquitously compared to 27.4% of non‐North American responders. Preoperative laryngeal exam was performed more universally by North American surgeons and more selectively by non‐North American surgeons (P < 0.001). Other attitudes toward their implementation and the postoperative laryngeal exam were similar. Surgeons ≤45 years of age and those with ≤15 years of practice used IONM more than their peers (P < 0.001). Thyroid surgery volume, fellowship training, and type of practice had no bearing on IONM use. Conclusion The prevalence of IONM in thyroid and parathyroid surgeries has increased significantly over the past decade, with 83% of surgeons using IONM in some or all cases. Although IONM use may be more ubiquitous in North America, attitudes toward its implementation and pre‐ and postoperative laryngeal exams are fairly uniform. IONM use is more prevalent among younger surgeons, whereas its use has no correlation with thyroid surgery volume or type of practice. Level of Evidence 4 Laryngoscope, 130:1097–1104, 2020

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“…Endotracheal tube–based nerve monitoring has become widely accepted as a standard for intraoperative neural monitoring during thyroid surgery . It is not, however, used without several limitations.…”

Section: Introductionmentioning

confidence: 99%

Trans–thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery

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et al. 2019

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International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal

Cited by 180 publications

References 142 publications

Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

Trans–thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery

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