Neural monitoring during ultrasound-guided radiofrequency ablation of thyroid nodules

Abstract

Background: Intraoperative neurological monitoring is important in locating and assessing nerves during surgery. This study aimed to investigate the feasibility of neural monitoring during ultrasoundguided radiofrequency ablation (RFA) of thyroid nodules. Methods: From February 2019 to August 2019, 16 patients (age, 42.8 ± 15.9 years; range, 17-74 years) with benign thyroid nodules who underwent ultrasound-guided RFA with neural monitoring in Zhongshan Hospital, Xiamen University, were included. A neuromonitoring system stimulated the vagus nerve to obtain electromyographic (EMG) signals and predict the function of recurrent laryngeal nerves (RLNs) during RFA. The hydrodissection technique was used to protect the RLN area. Thyroid nodules were treated with the moving-shot technique. The EMG signal value results were recorded and analyzed. All patients underwent laryngoscopic investigation 1 day after the procedure. Results: Twenty vagus nerves were stimulated preprocedure and postprocedure, and the EMG signals were successfully recorded (100%). The mean initial (before ablation) and final (final ablation) vagus nerve amplitudes were 612.7 ± 130.4 lV (range, 455-882 lV) and 592.7 ± 127.3 lV (range, 410-817 lV), respectively. Based on the EMG signals, all 20 RLNs were judged to be in good condition, consistent with the postprocedure laryngoscopic results. The maximum lesion size and volume at 6 months after RFA were significantly lesser than those at baseline (p < 0.05). The volume reduction rate was 68.5% ± 21.5% (range, 13.0-97.3%). Cosmetic and symptom scores were significantly lower than those at baseline. No complications from neural monitoring occurred. Conclusions: Neural monitoring during ultrasound-guided RFA of thyroid nodules is feasible to predict RLN function.

Microwave ablation with hydrodissection used for the treatment of vascular malformations: effectiveness and safety study

“…Therefore, hydrodissection around the VMs was needed to protect the surrounding tissues. If the injection of protective saline was not satisfactory in the operation, high temperature will lead to nerve damage (27)(28)(29)(30). Therefore, it is particularly important to evaluate neural safety preoperatively and to make corresponding plan of safe injection routes and neuroprotective strategy.…”

Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

“…Lin et al. conducted a retrospective cohort study of patients who underwent ultrasound- guided RFA of thyroid nodules between 2/2019 to 8/2019 using neuromonitoring with cutaneous electrodes ( 31 ). Inclusion criteria consisted of having a symptomatic nodule (discomfort, compressive symptoms, foreign body sensation), benign cytology on fine-needle aspiration, no BRAF mutation, normal thyroid function tests, and normal movement of the vocal cords on laryngoscopy.…”

Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

“…Complications arising from the nerval monitoring included pain, local hematoma, vasovagal reaction bradycardia, hypertension and vomiting. 100% of EMG signals were obtained demonstrating feasibility of IIONM during RFA ( 51 ).…”