Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients

Kim, Jina; Graves, Claire E.; Jin, Chengshi; Duh, Quan‐Yang; Gosnell, Jessica E.; Shen, Wen T.; Suh, Insoo; Sosa, Julie Ann; Roman, Sanziana A.

doi:10.1016/j.amjsurg.2020.10.013

Cited by 19 publications

(27 citation statements)

References 38 publications

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“…The auditory pathways can be monitored intraoperatively by short-latency BAEPs. To record BAEPs responses, auditory clicks stimulation in the ear are used, and these clicks are broadband sound range (500 to 4000 Hz) to deliver at various audio frequencies [ 17 - 19 ]. The most common causes of surgical injuries to the auditory system are surgical compression, traction, thermal and ischemic injuries.…”

Section: Methodsmentioning

confidence: 99%

Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar

Ali¹,

Jahangiri²,

Ali³

et al. 2021

Cureus

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Introduction Intraoperative neurophysiological monitoring (IONM) helps in better patient outcomes by minimizing risks related to the functional status of the nervous system during surgical procedures. An IONM alert to the surgical team during the surgery can help them identify the cause and take immediate corrective action. IONM confers possible benefits, including improved surgical morbidity and mortality, better patient care, minimal neurological deficits, reduced hospital stay, medical costs, and litigation risk. In addition, a highly skilled IONM team will make a better patient outcome. Methods We retrospectively reviewed 62 consecutive patients who underwent intracranial and spinal neurosurgical procedures. Multimodality IONM was utilized, including somatosensory evoked potentials, transcranial electrical motor evoked potential, spontaneous and triggered electromyography, electroencephalography, electrocorticography, cortical sensory mapping, and direct electrical cortical stimulation. Of a total of 62 patients, two patients revealed neurotonic EMG discharges during IONM, and most patients woke up without any new neurological deficit. Results Sixty-two patients were included, ranging from age 5 to 77 years (mean 43.5 years), with 54.8% men and 45.2% female. Multimodality IONM was used in all patients. Two EMG alerts were recorded during IONM, during a brain tumor resection, and right acetabular hip surgery with postoperative right foot drop. Conclusion Multimodality IONM is the gold standard of care for any surgical services and is used as real-time monitoring of functional integrity of neural structures at risk. If utilized by trained and expert teams, numerous surgeries may benefit from multimodality intraoperative neurophysiologic monitoring.

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Section: Methodsmentioning

confidence: 99%

Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar

Ali¹,

Jahangiri²,

Ali³

et al. 2021

Cureus

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“…With the improving data regarding the anatomy and function of the RLN, the use of intraoperative nerve monitoring (IONM), one of the technical and technological developments allowing functional evaluation of the nerve in addition to visual identification has been increasing recently ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…It has been demonstrated that the use of IONM reduces the risk of RLN injury ( 13 ), and continuous IONM (CIONM) is superior to intermittent IONM (IIONM) in preventing RLN injury ( 11 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical and Anatomical Factors Affecting Recurrent Laryngeal Nerve Paralysis During Thyroidectomy via Intraoperative Nerve Monitorization

et al. 2022

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BackgroundDespite all the technical developments in thyroidectomy and the use of intraoperative nerve monitorization (IONM), recurrent laryngeal nerve (RLN) paralysis may still occur. We aimed to evaluate the effects of anatomical variations, clinical features, and intervention type on RLN paralysis.MethodThe RLNs identified till the laryngeal entry point, between January 2016 and September 2021 were included in the study. The effects of RLN anatomical features considering the International RLN Anatomical Classification System, intervention and monitoring types on RLN paralysis were evaluated.ResultsA total of 1,412 neck sides of 871 patients (672 F, 199 M) with a mean age of 49.17 + 13.42 years (range, 18–99) were evaluated. Eighty-three nerves (5.9%) including 78 nerves with transient (5.5%) and 5 (0.4%) with permanent vocal cord paralysis (VCP) were detected. The factors that may increase the risk of VCP were evaluated with binary logistic regression analysis. While the secondary thyroidectomy (OR: 2.809, 95%CI: 1.302–6.061, p = 0.008) and Berry entrapment of RLN (OR: 2.347, 95%CI: 1.425–3.876, p = 0.001) were detected as the independent risk factors for total VCP, the use of intermittent-IONM (OR: 2.217, 95% CI: 1.299–3.788, 0.004), secondary thyroidectomy (OR: 3.257, 95%CI: 1.340–7.937, p = 0.009), and nerve branching (OR: 1.739, 95%CI: 1.049–2.882, p = 0.032) were detected as independent risk factors for transient VCP.ConclusionPreference of continuous-IONM particularly in secondary thyroidectomies would reduce the risk of VCP. Anatomical variations of the RLN cannot be predicted preoperatively. Revealing anatomical features with careful dissection may contribute to risk reduction by minimizing actions causing traction trauma or compression on the nerve.

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“…1,2 It facilitates identification of the nerve and allows prediction of postoperative RLN function. [1][2][3][4] The use of IONM seems to reduce RLN injury rate in thyroidectomy compared to that with direct visual identification, [5][6][7] although some meta-analysis studies failed to show statistically significant results. 8,9 In particular, IONM is useful in high-risk patients undergoing reoperation or in those with malignancy or retrosternal goiter.…”

Section: Introductionmentioning

confidence: 99%

Success rate and learning curve of intraoperative neural monitoring of the external branch of the superior laryngeal nerve in thyroidectomy

Choi

Kim

et al. 2021

Head & Neck

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Background: This study aimed to evaluate the success rate and learning curve of intraoperative neural monitoring (IONM) of the external branch of the superior laryngeal nerve (EBSLN) in thyroidectomy.Methods: We studied 130 consecutive patients (200 nerves at risk [NARs]) who had undergone conventional thyroidectomy with IONM of the recurrent laryngeal nerve (RLN) and EBSLN from January 2017 to March 2020. The learning curve was defined as the number of NARs required to achieve an effective and reliable neuromonitoring rate.Results: IONM of the EBSLN was successful in 136/200 (68%) NARs. The cutoff point of the learning curve was 45 NARs (28 patients). The neural identification rate of EBSLN was significantly higher in the post-learning 155 NARs group than the pre-learning group (82.6% vs. 17.8%, p < 0.001).Conclusions: Approximately 45 NAR neuromonitoring attempts were required to reach a significant increase in the EBSLN identification rate and overcome the learning curve.

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Intraoperative nerve monitoring is associated with a lower risk of recurrent laryngeal nerve injury: A national analysis of 17,610 patients

Cited by 19 publications

References 38 publications

Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar

Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar

Clinical and Anatomical Factors Affecting Recurrent Laryngeal Nerve Paralysis During Thyroidectomy via Intraoperative Nerve Monitorization

Success rate and learning curve of intraoperative neural monitoring of the external branch of the superior laryngeal nerve in thyroidectomy

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