Signalstabilität als Grundvoraussetzung für kontinuierliches intraoperatives Neuromonitoring

Abstract

According to the data, only the saxophone-shaped backstrap electrode provided the signal stability required for CIONM. The closed electrode geometry with isolated contacts for nerve stimulation and defined current entry provide the prerequisites required for reliable continuous intraoperative neuromonitoring.

Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures

“…The positive identi-fication of the vagal nerve is heard from an audible signal and also is seen as a corresponding biphasic waveform EMG signal on the IONM monitor, which reflects an intact RLN. 14 It is important to consider the possibility of neuroanatomic variations that could prevent desired innervations of the APS. Finally, attempts were made to keep the surgical field dry with a swab to avoid any artifacts and/ or signal shunting.…”

Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery

“…The CIONM system used for this study has been developed within the scope of the IKONA consortium and is currently under clinical evaluation. 11,12 The consortium is an association of academic and industrial institutions (Fraunhofer Institute IBMT, St. Ingbert, Germany; Johannes Guttenberg University, Mainz, Germany; Inomed GmbH, Emmendingen, Germany; Osypka AG, Rheinfelden, Germany; Rheinhardt Microtech, Ulm, Germany; Robert Bosch Hospital, Stuttgart, Germany). In the presented study, a new tripolar vagal stimulation electrode was used for CIONM that facilitates stable intraoperative VNS.…”

“…IONM was conducted as previously reported, and fixed stimulation settings with amplitudes of 5 mA at a pulse width of 200 lsec and a pulse rate of 3/s were applied. [6][7][8]11,12 In the intervention group CIONM was interrupted automatically by the applied EMG system (ISIS, Inomed GmbH) during manual nerve identification.…”

“…Thyroid and parathyroid surgeries were performed as routine interventions with CIONM as described previously. 12 A newly developed stimulation electrode was used for VNS. The stimulation electrode was placed around the vagus nerve before beginning of the actual organ preparation.…”

“…First results from clinical trials have been reported and appear promising. [8][9][10][11][12] However, the number of patients operated on applying CIONM is still small, and side effects of electrical VNS have been described for its therapeutic indications in the fields of neurology and psychiatry. As a mixed cranial nerve, the vagus nerve carries special and general visceral afferents and efferents.…”