Neural monitoring in thyroid surgery
Abstract
Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in Centers highly specialized in thyroid surgery.
Keywords
Full Text:
PDFReferences
1. Sala, F. (2010). Intraoperative neurophysiology is here to stay. Childs Nerv Syst, 26(4):413-7. doi: 10.1007/s00381-010-1090-5.
2. Riddell, V. (1970). Thyroidectomy: prevention of bilateral recurrent nerve palsy. Results of identification of the nerve over 23 consecutive years (1946–69) with a description of an additional safety measure. Br J Surg, 57:1-11.
3. Barczyński, M., Konturek, A., Cichoń, S. (2009). Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg, 96:240-6.
4. Randolph, G.W., Dralle, H., Abdullah, H, Barczynski, M., Bellantone, R., Brauckhoff, M. (2011). Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope, 121 Suppl 1:S1-16.
5. Schneider, R., Sekulla, C., Machens, A., Lorenz, K., Thanh, P.N., Dralle, H. (2016). Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function. Head Neck, 38 Suppl 1:E1144-51.
6. Kim, H.Y., Tufano, R.P., Randolph, G., Barczyński, M., Wu, C.W., Chiang, F.Y., Liu, X., Masuoka, H., Miyauchi, A., Park, S.Y., Kwak, H.Y., Lee, H.Y., Dionigi, G. Korean Intraoperative Neural Monitoring Society (KINMoS). (2016). Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment. Head Neck, 38 Suppl 1:E1004-8. doi: 10.1002/hed.24145.
7. Loch-Wilkinson, T.J., Stalberg, P.L., Sidhu, S.B., Sywak, M.S., Wilkinson, J.F., Delbridge, L.W. (2007). Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg, 77(5):377-80.
8. Sitges-Serra, A., Fontané, J., Dueñas, J.P., Duque, C.S., Lorente, L., Trillo, L., Sancho, J.J. (2013). Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy. Br J Surg, 100(5):662-6. doi: 10.1002/bjs.9044.
9. Carlander, J., Wagner, P., Gimm, O., Nordenström, E., Jansson, S., Bergkvist, L., Johansson, K. (2016). Risk of Complications with Energy-Based Surgical Devices in Thyroid Surgery: A National Multicenter Register Study. World J Surg, 40(1):117-23.
10. Whitfield, P.C., Kirkpatrick, P. (2001). Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev, 2. Art. No.: CD001697
11. Tator, C.H., (2006). Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations. Neurosurgery, 59:957–982
12. Wilson, L., Lin, E., Lalwani, A. (2003). Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery. Laryngoscope, 113(10):1736-45.
13. Dralle, H., Sekulla, C., Lorenz, K., (2008). German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg, 32:1358-66.
14. Kim, H.Y., Liu, X., Sun, H., Wu, C.W., Chai, Y.J., Chung, W.Y., Tufano, R., Dralle, H., Lavazza, M., Dionigi, G. (2017). Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery. J Endocr Surg, 17(2):42-56
15. Dralle, H., Schneider, R., Lorenz, K., Phuong, N.T., Sekulla, C., Machens, A. (2015). Vocal cord paralysis after thyroid surgery : Current medicolegal aspects of intraoperative neuromonitoring. Chirurg, 86(7):698-706. doi: 10.1007/s00104-015-0033-9.
16. Dralle, H. (2015). Surgical assessment of complications after thyroid gland operations. Chirurg, 86(1):70-7. doi: 10.1007/s00104-014-2819-6.
17. Dralle, H., Lorenz, K., Machens, A. (2012). Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions. Head Neck, 34(11):1591-6. doi: 10.1002/hed.21970.
18. Dionigi, G., Bartolo, V., Rizzo, A.G., Marullo, M., Fabiano, V., Catalfamo, A., Pergolizzi, F.P., Cancellieri, A., Melita, G. (2018). Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure. J Endocr Surg, 18:e2
19. Dionigi, G., Sun, H., Chai, Y.J., Catalfamo, A., Mangraviti, A., Rizzo, G.A., Portinari, M., Wu, C.W. (2017). Bilateral Vocal Palsy After Total Thyroidectomy: Expert Opinion on Two Malpractice Claims. J Endocr Surg, 17(4):139-148
20. Wang, T., Kim, H.Y., Wu, C.W., Rausei, S., Sun, H., Pergolizzi, F.P., Dionigi, G. (2017). Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery. Int J Surg, 48:180-188. doi: 10.1016/j.ijsu.2017.10.003.
21. Sanabria, Á., Ramírez, A. (2015). Economic analysis of routine neuromonitoring of recurrent laryngeal nerve in total thyroidectomy. Biomedica, 35(3):363-71. doi: 10.7705/biomedica.v35i3.2371.
22. Rocke, D.J., Goldstein, D.P., de Almeida, J.R. (2016). A Cost-Utility Analysis of Recurrent Laryngeal Nerve Monitoring in the Setting of Total Thyroidectomy. JAMA Otolaryngol Head Neck Surg, 142(12):1199-1205. doi: 10.1001/jamaoto.2016.2860.
23. Al-Qurayshi, Z., Kandil, E., Randolph, G.W. (2017). Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. Br J Surg, 104(11):1523-1531. doi: 10.1002/bjs.10582.
DOI: https://doi.org/10.6092/1828-6550/APMB.106.1.2018.SD1
Refbacks
- There are currently no refbacks.
Copyright (c) 2018 Gianlorenzo Dionigi, Antonina Catalfamo, Fausto Famà, Francesca Pia Pergolizzi

This work is licensed under a Creative Commons Attribution 4.0 International License.