Noninvasive Continuous Vagal-Nerve Monitoring, Harnessing the Primitive Laryngeal Adductor Reflex, Is on the Horizon

Abstract Purpose of Review Purpose of the present review is to illustrate the current state of the art concerning continuous intraoperative recurrent laryngeal nerve monitoring (cIONM) for thyroid surgery. Recent Findings cIONM potentially leads to an improved postoperative vocal cord palsy rate, compared to the intermittent technique. There are currently two main approaches for cIONM: either conventional cIONM based on vagal nerve stimulation or experimental methods, which do not require the positioning of a vagal nerve electrode. One of these methods is the recently described technique “LAR-cIONM,” which utilizes the laryngeal adductor reflex. Summary cIONM represents an advancement of intermittent nerve monitoring, which allows for an immediate reaction to signal changes. Threshold values and guidelines to prevent recurrent laryngeal nerve palsy were validated for the direct stimulation of the vagal nerve and require verification for alterative cIONM methods, including LAR-cIONM.

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

The Laryngoscope ◽

10.1002/lary.23411 ◽

2012 ◽

Vol 122 (9) ◽

pp. 1979-1987 ◽

Cited By ~ 27

Author(s):

Colin Friedrich ◽

Christoph Ulmer ◽

Fabian Rieber ◽

Eva Kern ◽

Andrea Kohler ◽

...

Keyword(s):

Nerve Stimulation ◽

Thyroid Surgery ◽

Safety Analysis ◽

Vagal Nerve ◽

Vagal Nerve Stimulation ◽

Nerve Monitoring

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A novel approach to neurologic function sparing surgical management of vagal schwannomas: Continuous intraoperative nerve monitoring of the laryngeal adductor reflex

Head & Neck ◽

10.1002/hed.25793 ◽

2019 ◽

Vol 41 (9) ◽

Cited By ~ 1

Author(s):

Mykayla L. Sandler ◽

John R. Sims ◽

Catherine Sinclair ◽

Rebecca Ho ◽

Lauren E. Yue ◽

...

Keyword(s):

Surgical Management ◽

Nerve Monitoring ◽

Novel Approach ◽

Neurologic Function ◽

Laryngeal Adductor Reflex ◽

Intraoperative Nerve Monitoring

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T99. Assessing lower brainstem and vagal nerve integrity during posterior fossa surgery by using the laryngeal adductor reflex. Escalating intraoperative neuromonitoring of the lower brainstem

Clinical Neurophysiology ◽

10.1016/j.clinph.2018.04.100 ◽

2018 ◽

Vol 129 ◽

pp. e40

Author(s):

Vizmary J. Montes Peña ◽

Jose Luis Boada Cuellar ◽

Diego Rodriguez MenA ◽

Jesus Aguas Valiente ◽

Juan F. Sanchez Ortega ◽

...

Keyword(s):

Posterior Fossa ◽

Intraoperative Neuromonitoring ◽

Vagal Nerve ◽

Posterior Fossa Surgery ◽

Laryngeal Adductor Reflex

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Intraoperative Vagal Nerve Monitoring

Ear Nose & Throat Journal ◽

10.1177/014556139607500807 ◽

1996 ◽

Vol 75 (8) ◽

pp. 489-496 ◽

Cited By ~ 8

Author(s):

John P. Leonetti ◽

W. Scott Jellish ◽

Patricia Warf ◽

Elizabeth Hudson

Keyword(s):

Skull Base ◽

Vocal Cord ◽

Infratemporal Fossa ◽

Tumor Resection ◽

Vagal Nerve ◽

Malignant Neoplasms ◽

Nerve Monitoring ◽

Lateral Skull Base ◽

Vagal Nerves ◽

Functional Preservation

A variety of benign and malignant neoplasms occur in the superior cervical neck, parapharyngeal space or the infratemporal fossa. The surgical resection of these lesions may result in postoperative iatrogenic injury to the vagus nerve with associated dysfunctional swallowing and airway protection. Anatomic and functional preservation of this critical cranial nerve will contribute to a favorable surgical outcome. Fourteen patients with tumors of the cervical neck or adjacent skull base underwent intraoperative vagal nerve monitoring in an attempt to preserve neural integrity following tumor removal. Of the 11 patients with anatomically preserved vagal nerves in this group, seven patients had normal vocal cord mobility following surgery and all 11 patients demonstrated normal vocal cord movement by six months. In an earlier series of 23 patients with tumors in the same region who underwent tumor resection without vagal nerve monitoring, 18 patients had anatomically preserved vagal nerves. Within this group, five patients had normal vocal cord movement at one month and 13 patients demonstrated normal vocal cord movement at six months. This paper will outline a technique for intraoperative vagal nerve monitoring utilizing transcricothyroid membrane placement of bipolar hook-wire electrodes in the vocalis muscle. Our results with the surgical treatment of cervical neck and lateral skull base tumors for patients with unmonitored and monitored vagal nerves will be outlined.

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