Ultrasound visualization of the vagus nerve for intraoperative neuromonitoring in thyroid surgery

Intraoperative neuromonitoring during thyroid surgery has been used to successfully prevent permanent neurological injury by early identification of anatomical variants. Proper interpretation of neuromonitoring data requires knowledge of what factors might affect the data. In this study, we examined the effect of surgical positioning on the latency and amplitude of neural recordings made from the vocalis muscle during thyroid surgery. A retrospective review was performed of 145 patients who underwent thyroid surgery. Eighty-three had open cervical procedures, and 62 had robotic-assisted transaxillary procedures. Intraoperative neuromonitoring recordings were made by stimulation of the vagus and recurrent laryngeal nerves for both groups. Ultrasound measurements were made of a subset of the transaxillary patients immediately before and after arm positioning. Groups differed only on right-sided recordings. Patients with transaxillary surgeries had significantly shorter latencies evoked from the vagus nerve. We found that vagus nerve–evoked latencies were also correlated to ultrasound measurements of the nerves. Surgical positioning during thyroid surgery is a factor that may affect intraoperative neuromonitoring data and should be taken into account by the surgeon during interpretation.

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Intraoperative neuromonitoring by vagus nerve stimulation in thyroid surgery: Clinical assessment of recurrent and superior laryngeal nerves

European Annals of Otorhinolaryngology Head and Neck Diseases ◽

10.1016/j.anorl.2020.04.005 ◽

2020 ◽

Vol 137 (3) ◽

pp. 227-230

Author(s):

J.-M. Prades ◽

Y. Lelonge ◽

B. Farizon ◽

M.-D. Dubois ◽

M. Gavid

Keyword(s):

Vagus Nerve ◽

Clinical Assessment ◽

Nerve Stimulation ◽

Thyroid Surgery ◽

Vagus Nerve Stimulation ◽

Intraoperative Neuromonitoring ◽

Laryngeal Nerves

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Transcranial motor-evoked potentials of laryngeal muscles for intraoperative neuromonitoring of the vagus nerve during thyroid surgery

Journal of Anesthesia ◽

10.1007/s00540-018-2601-x ◽

2019 ◽

Vol 33 (2) ◽

pp. 221-229 ◽

Cited By ~ 3

Author(s):

Takashi Ichino ◽

Satoshi Tanaka ◽

Ryusuke Tanaka ◽

Naruaki Tanaka ◽

Takashi Ishida ◽

...

Keyword(s):

Evoked Potentials ◽

Vagus Nerve ◽

Thyroid Surgery ◽

Motor Evoked Potentials ◽

Intraoperative Neuromonitoring ◽

Laryngeal Muscles ◽

Transcranial Motor Evoked Potentials

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Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2020.00822 ◽

2021 ◽

Vol 64 (6) ◽

pp. 416-421

Author(s):

Sang Gyu Seo ◽

Hyoung Shin Lee ◽

Ki Hun Jo ◽

Sung Won Kim ◽

Kang Dae Lee

Keyword(s):

At Risk ◽

Vagus Nerve ◽

Vocal Cord ◽

Thyroid Surgery ◽

Standard Procedure ◽

Thyroid Cartilage ◽

Intraoperative Neuromonitoring ◽

Skin Electrodes ◽

Clinicopathologic Factors ◽

The Mean

Background and Objectives Variable types of electrodes for intraoperative neuromonitoring (IONM) during thyroid surgery have been introduced to make up for the shortcomings of conventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacy of transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN) during thyroidectomy.Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals of vagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors as well as the preoperative and postoperative vocal cord functions of the patients were analyzed.Results IONM was successful in all nerves at risk without any false loss of signals. There were no complications nor any significant time delay due to adhesive skin electrodes. The mean amplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 µV and 293.48 µV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporary vocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantly higher in the lower body mass index (BMI) group compared to that of the higher BMI group.Conclusion IONM using transcutaneous skin electrodes may be considered as an alternative technique for IONM during thyroid surgery.

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Intraoperative Neuromonitoring of the laryngeal nerves in thyroid surgery

Endocrine Abstracts ◽

10.1530/endoabs.63.p361 ◽

2019 ◽

Author(s):

Mikhail O Vozdvizhenskii ◽

AE Orlov ◽

AA Makhonin ◽

VV Stadler ◽

Ya.S Matyash

Keyword(s):

Thyroid Surgery ◽

Intraoperative Neuromonitoring ◽

Laryngeal Nerves

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INTRAOPERATIVE CONTINUOUS NEUROMONITORING OF LARYNGEAL RECCURENT NERVES IN PATIENTS WITH THYROID CANCER

Problems in oncology ◽

10.37469/0507-3758-2019-65-3-342-348 ◽

2019 ◽

Vol 65 (3) ◽

pp. 342-348

Author(s):

Viktor Makarin ◽

Anna Uspenskaya ◽

Arseniy Semenov ◽

Natalya Timofeeva ◽

Roman Chernikov ◽

...

Keyword(s):

Thyroid Cancer ◽

Postoperative Complications ◽

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Intraoperative Neuromonitoring ◽

Laryngeal Nerve ◽

Laryngeal Muscles ◽

Neural Transmission ◽

Continuous Neuromonitoring ◽

Surgical Manipulation

Laryngeal muscles paresis ranks second in prevalence of postoperative complications after thyroid surgery. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) results in reduction of cases with dysphonia and prevents such severe complication as bilateral paresis. Currently there are two types of monitoring: intermittent and continual. When using intermittent IONM surgeon has no opportunity to control electrophysiology state of RLN during intervals between stimulations. In case of continual IONM date on amplitude and latency are available to surgeon in real time every second, allowing him instantly react to any disturbance of neural transmission to prevent its damage by changing surgical manipulation. This work presents the first experience of using continual neuromonitoring of RLN in Russia, the procedure is described in details its safety. It is represented the possibility of prevention of bilateral laryngeal muscles paresis.

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