Kontinuierliches intraoperatives Neuromonitoring (cIONM) in der Kopf-Hals-Chirurgie – eine Übersicht

Abstract

Kontinuierliches intraoperatives Neuromonitoring (cIONM) in der Kopf-Hals-Chirurgie-eine Übersicht Intraoperatives Neuromonitoring (IONM) zielt darauf ab, gefährdete neuronale Strukturen anatomisch und funktionell zu erhalten und so postoperativ temporäre und dauerhafte Paresen zu vermeiden. Modernes IONM ermöglicht nicht nur Nervenidentifizierung, sondern auch die Erkennung potenziell schädlicher Manipulationen; so kann anhand der intraoperativen Informationen eine Vorhersage der postoperativen Funktion erfolgen. Im Kopf-Hals-Bereich ist das IONM in der HNO-Heilkunde, Neurochirurgie und Schilddrüsenchirurgie etabliert. Hintergrund Die Geschichte des intraoperativen Neuromonitorings (IONM) reicht bis ins Jahr 1898 zurück, als Dr. Fedor Krause aus Berlin die monopolare faradische Stimulation bei der Neurektomie des N. vestibulocochlearis als Therapie eines dekompensierten Tinnitus zur Identifikation des N. facialis einsetzte [13]: Hierbei stimulierte er den Gesichtsnerv und stellte visuell fest, dass Kontraktionen der Ge-Die englische Version dieses Beitrags ist unter

Length of hospital stay and complications of mini-facelift versus modified Blair incision for parotid abscess drainage

“…Although an elevated nerve response (0.5 mA) could predict postoperative facial nerve paresis at the end of procedure, an absence of an electrically evoked response does not exclude the facial nerve injury (15,17). The incidence of temporary postoperative facial weakness in our cohort is much lower than that in the recent meta-analysis (1.7% vs. 23.4%, adjusted OR 0.06, 95% CI 0.01 to 0.23, P = 0.0001) (16). Possible explanations are that most data in that meta-analysis were based on studies with 2-channel systems during parotidectomy, while we used passive 4 channel-monitoring (electrode placement in the frontal, orbicularis oculi and oris, and mentalis muscles).…”

“…Dissection, transaction, laceration, clamp compression, retraction, electrocautery, ligature entrapment, suction trauma, or even compressive ischemia can cause iatrogenic facial nerve injury ( 17 ). cIONM during parotid surgery allows early nerve identification, forewarns surgeons of unexpected facial nerve stimulation, maps the nerve course, reduces mechanical nerve damage, and helps to evaluate and prognosticate the nerve function at the end of the procedure ( 15 , 16 ). This real-time monitoring of the facial nerve undoubtedly decreases operation time and increases patient satisfaction ( 17 ).…”

“…In the MFL group, the patients were informed about the chance of intraoperative converting the incision into the conventional MBI, depending on surgical difficulty. All subjects received routine use of general anaesthetics and continuous intraoperative neuromonitoring (cIONM) of the facial nerve, as described by other authors ( 15 , 16 , 17 ). Subjects were excluded from the study if they did not satisfy the inclusion criteria, had poor general health (American Society of Anesthesiology [ASA] status IIIIV), or if infection became disseminating to other tissues/ organs or arose from a tumor (“tumor necrosis”).…”

Continuous Intraoperative Nerve Monitoring of a Non-Recurrent Laryngeal Nerve: Real-Life Data of a High-Volume Thyroid Surgery Center

“…In our evaluation, two patients showed a permanent drop of the cIONM signal amplitude during surgery without a clinically apparent VCP after surgery. One might say that cIONM overestimates the occurrence of nerve injury, but it is known that the loss of cIONM signal (LOS) occurs after a multiple combined event (mCE, a combination of a drop of the cIONM signal amplitude below the 50% threshold and an increase in latency of 10%) [ 15 , 32 ]. LOS is associated with nerve injury and the consecutive VCP [ 15 ].…”

“…Therefore, cIONM constitutes an early warning system to prevent VCP. The safety of cIONM has been demonstrated in a variety of publications [ 32 ]. Side effects are rare and usually completely reversible after removal of the stimulation electrode [ 32 , 33 ].…”