Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring

Schneider, Rick; Machens, Andreas; Sekulla, Carsten; Lorenz, Kerstin; Weber, Frank; Dralle, Henning

doi:10.1002/bjs.10792

Cited by 49 publications

(47 citation statements)

References 22 publications

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“…Despite the many advantages of ET electrodes, there are also problems in terms of verification, maintenance, stability, patient selection and operative use ( Table S1, supporting information). Proper placement of the ET with complete contact with the mucosa of the vocal cords is essential to minimize monitoring problems, specifically to obtain the best impedance, thus providing a precise EMG profile and exact determination of loss of signal, and allowing differentiation between signal and artefact.…”

Section: Introductionmentioning

confidence: 99%

Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

Zhao

et al. 2019

Journal of British Surgery

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Background Needle electrodes placed on the thyroid cartilage (TC) are an alternative to endotracheal tube (ET) electrodes for assessing recurrent laryngeal nerve (RLN) function during thyroid surgery. Needle electrodes placed on the TC were evaluated in an experimental porcine model. Methods Continuous intraoperative neuromonitoring was used to record the electromyogram. Each TC side was delineated into nine areas to determine the optimal placement of the electrode, and needle electrode area, depth and orientation for optimal electromyographic (EMG) amplitudes were evaluated. RLN root locations were stimulated at four locations: vagus nerve distal to the neuromonitoring electrode, and most proximal, middle and laryngeal entry points of the nerve. A nerve retraction injury model was adapted to compare RLN monitoring by TC versus ET electrodes. Results An optimal site for placement of needle electrodes was identified, and electromyograms obtained from the various needle insertion depths and orientations were similar. Latencies recorded from the TC and ET electrodes were similar. The amplitude profile of TC electrodes responded earlier to RLN injury than that of ET electrodes. Amplitude and drop to loss of signal were also registered earlier. Conclusion EMG amplitudes obtained using TC electrodes were higher, and identified RLN injury earlier than ET electrodes. Needle electrodes placed on the thyroid cartilage (TC) are an alternative to endotracheal tube (ET) electrodes for assessing the function of the recurrent laryngeal nerve (RLN) in thyroid surgery.This study used an experimental porcine model to evaluate the use of needle electrodes inserted in the TC, compared with ET electrodes, for producing an electromyographic (EMG) profile of the RLN. Nine areas of the TC, with various needle insertion depths and orientations, were compared. Perichondral insertion into the avascular area of the TC was found to be safe. The EMG amplitude and latency features recorded via the TC and ET electrodes were compared, using both intermittent and continuous monitoring. Changes in EMG amplitudes in response to nerve traction injury were registered earlier with TC electrodes than with ET electrodes, and the amplitudes were higher and more stable. Latencies obtained via the TC and ET electrodes were similar.These results indicate that the development of a non‐invasive monitoring electrode with improved function, easy placement and low cost is possible.

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Section: Introductionmentioning

confidence: 99%

Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

Zhao

et al. 2019

Journal of British Surgery

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“…CIONM is thought to reduce permanent vocal fold palsy rates more effectively than IIONM (0% vs. 0.4%; P = .019) because it measures nerve electrophysiology more accurately, and continually verifies functional integrity of the vagus–RLN axis in real‐time. Altogether, CIOMN facilitates reversal of the injurious surgical maneuver associated with the electromyogram (EMG) alteration by alerting the surgeon to impending nerve injury …”

Section: Introductionmentioning

confidence: 99%

Prediction of Postoperative Vocal Fold Function After Intraoperative Recovery of Loss of Signal

et al. 2018

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Objectives/Hypothesis This multicenter study aimed to 1) evaluate early postoperative vocal fold function in relation to intraoperative amplitude recovery, and 2) determine optimal absolute and relative thresholds of intraoperative amplitude recovery heralding normal early postoperative vocal fold function, both after segmental type 1 and after global type 2 loss of signal (LOS). Study Design Prospective outcome study. Methods This study, encompassing nine surgical centers from four countries, correlated intraoperative amplitude recovery with early postoperative vocal fold function using receiver operating characteristic analysis. Results Included in this study were 68 patients, 48 women and 20 men, who sustained transient recurrent laryngeal nerve injury during thyroid surgery under continuous intraoperative nerve monitoring. Early transient vocal fold palsy was seen in 18 (64%) of 28 patients with ipsilateral segmental LOS type 1, and in 10 (25%) of 40 patients with ipsilateral global LOS type 2. On receiver operating characteristic analysis, relative amplitude thresholds were superior to absolute amplitude thresholds in predicting vocal fold function after LOS type 2 (area under the curve [AUC]: 0.83 vs. 0.65; P = .01 vs. P = .15; Youden index 44% and 253 µV) and LOS type 1 (AUC: 0.96 vs. 0.97; P < .001 each; Youden index 49% and 455 µV). Amplitude recovery ≥50% of baseline after LOS always indicated intact vocal fold function. Conclusions When the nerve amplitude recovers ≥50% of baseline after segmental LOS type 1 or global LOS type 2, it is appropriate to extend completion thyroidectomy to the other side during the same session. Level of Evidence 2b Laryngoscope, 129:525–531, 2019

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“…[8][9][10] Schneider et al reported normative IONM data on children undergoing thyroid surgery, including the impact of age on basal amplitude and latency. 11 To our knowledge, these are the only normative VEMG data available in the literature stratified by age in children. Here, we use the application of VEMG in the chronic injury setting as a new technique offered for better interpretation of neural circuit status.…”

Section: Introductionmentioning

confidence: 98%

“…Intraoperative nerve monitoring (IONM) has gained widespread acceptance during thyroid and parathyroid surgery, with vagal electromyography (VEMG) employed as a useful adjunct . Schneider et al reported normative IONM data on children undergoing thyroid surgery, including the impact of age on basal amplitude and latency . To our knowledge, these are the only normative VEMG data available in the literature stratified by age in children.…”

Section: Introductionmentioning

confidence: 99%

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Vagal stimulation and laryngeal electromyography for recurrent laryngeal reinnervation in children

et al. 2019

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Ansa‐to‐recurrent laryngeal nerve (ANSA‐RLN) reinnervation procedures are now often first‐line treatments for some children with unilateral vocal fold immobility. Although many describe that children with prolonged denervation and true vocal fold atrophy should not undergo this procedure, there has been no gold‐standard means of identifying true denervation. Here, we describe a novel technique using evoked vagal electromyography to predict degree of chronic nerve injury prior to recurrent laryngeal nerve reinnervation in children. This is a simple, readily available technique that may play an important role in predicting likelihood of success with pediatric ANSA‐RLN reinnervation. Laryngoscope, 130:747–751, 2020

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Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring

Abstract: Continuous IONM measures nerve electrophysiology more accurately than intermittent IONM during thyroidectomy in children.

Cited by 49 publications

References 22 publications

Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery

Prediction of Postoperative Vocal Fold Function After Intraoperative Recovery of Loss of Signal

Vagal stimulation and laryngeal electromyography for recurrent laryngeal reinnervation in children

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