scholarly journals Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes

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.

scholarly journals Intraoperative Neuromonitoring During Thyroid Surgery: The Effect of Surgical Positioning

2018 ◽  
Vol 26 (1) ◽  
pp. 77-81
Author(s):  
Jason E. Crowther ◽  
Daniah Bu Ali ◽  
Jeremy Bamford ◽  
San-Wook Kang ◽  
Emad Kandil
Keyword(s):  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Neurological Injury ◽  
Neural Recordings ◽  
Surgical Positioning ◽  
Ultrasound Measurements ◽  
Before And After ◽  
Recurrent Laryngeal Nerves ◽  
Proper Interpretation

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.

scholarly journals Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy

2020 ◽  
pp. 014556132090632
Author(s):  
Kinyas Kartal ◽  
Nurcihan Aygun ◽  
Mustafa Fevzi Celayir ◽  
Evren Besler ◽  
Bulent Citgez ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Thyroid Surgery ◽  
Health Care Professionals ◽  
Surgical Techniques ◽  
Vocal Cord Palsy ◽  
Intraoperative Neuromonitoring ◽  
Efficient Tool ◽  
Group 2 ◽  
Neural Monitoring ◽  
Group 1

Objectives: This study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery. Methods: Data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines. Results: In total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively ( P = .005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; P = .230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; P = .341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 ( P = .033). Conclusions: Intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.

scholarly journals Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jongjin Kim ◽  
Hyeon Jong Moon ◽  
Young Jun Chai ◽  
Jung-Man Lee ◽  
Ki-Tae Hwang ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Medical Records ◽  
Electric Stimulation ◽  
Intraoperative Neuromonitoring ◽  
Vagus Nerves ◽  
Nerve Monitoring ◽  
Continuous Feedback ◽  
The Mean ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring

Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

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

2020 ◽  
Author(s):  
Dana M. Hartl ◽  
Sophie Bidault ◽  
Elizabeth Girard ◽  
Joanne Guerlain ◽  
Ingrid Breuskin ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring

Results of Intraoperative Neuromonitoring in Thyroid Surgery and Preoperative Vocal Cord Paralysis

2013 ◽  
Vol 38 (3) ◽  
pp. 582-591 ◽  
Author(s):  
Kerstin Lorenz ◽  
Mohammed Abuazab ◽  
Carsten Sekulla ◽  
Rick Schneider ◽  
Phuong Nguyen Thanh ◽  
...  
Keyword(s):  
Vocal Cord ◽  
Thyroid Surgery ◽  
Vocal Cord Paralysis ◽  
Intraoperative Neuromonitoring

Discriminant Validation of the Test of Reading Performance (TORP) for Identifying Children at Risk of Reading Difficulties

2000 ◽  
Vol 16 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Padeliadu Susana ◽  
Georgios D. Sideridis
Keyword(s):  
At Risk ◽  
Elementary School Students ◽  
Reading Difficulties ◽  
Reading Performance ◽  
Low Achievers ◽  
Children At Risk ◽  
School Students ◽  
Students At Risk ◽  
Group A ◽  
The Mean

Abstract This study investigated the discriminant validation of the Test of Reading Performance (TORP), a new scale designed to evaluate the reading performance of elementary-school students. The sample consisted of 181 elementary-school students drawn from public elementary schools in northern Greece using stratified random procedures. The TORP was hypothesized to measure six constructs, namely: “letter knowledge,” “phoneme blending,” “word identification,” “syntax,” “morphology,” and “passage comprehension.” Using standard deviations (SD) from the mean, three groups of students were formed as follows: A group of low achievers in reading (N = 9) including students who scored between -1 and -1.5 SD from the mean of the group. A group of students at risk of reading difficulties (N = 6) including students who scored between -1.5 and -2 SDs below the mean of the group. A group of students at risk of serious reading difficulties (N = 6) including students who scored -2 or more SDs below the mean of the group. The rest of the students (no risk, N = 122) comprised the fourth group. Using discriminant analyses it was evaluated how well the linear combination of the 15 variables that comprised the TORP could discriminate students of different reading ability. Results indicated that correct classification rates for low achievers, those at risk for reading problems, those at risk of serious reading problems, and the no-risk group were 89%, 100%, 83%, and 97%, respectively. Evidence for partial validation of the TORP was provided through the use of confirmatory factor analysis and indices of sensitivity and specificity. It is concluded that the TORP can be ut ilized for the identification of children at risk for low achievement in reading. Analysis of the misclassified cases indicated that increased variability might have been responsible for the existing misclassification. More research is needed to determine the discriminant validation of TORP with samples of children with specific reading disabilities.

Implanted vagus nerve stimulation in 126 patients: surgical technique and complications

2020 ◽  
Vol 99 (7) ◽  
Keyword(s):  
Vagus Nerve ◽  
Vocal Cord ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Pulse Generator ◽  
Operative Procedure ◽  
Intractable Epilepsy ◽  
Vagal Nerve ◽  
University Hospital ◽  
Nerve Stimulator

Introduction: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy to reduce the frequency and intensity of seizures. A bipolar helical electrode is placed around the left vagus nerve at the cervical level and is connected to the pulse generator placed in a subcutaneous pocket, most commonly in the subclavian region. Methods: Between March 1998 and October 2019, we performed 196 procedures related to the vagal nerve stimulation at the Neurosurgery Department in Motol University Hospital. Of these, 126 patients were vagal nerve stimulator implantation surgeries for intractable epilepsy. The cases included 69 female and 57 male patients with mean age at the time of the implantation surgery 22±12.4 years (range 2.1−58.4 years). Results: Nine patients (7.1%) were afflicted by complications related to implantation. Surgical complications included postoperative infection in 1.6%, VNS-associated arrhythmias in 1.6%, jugular vein bleeding in 0.8% and vocal cord paresis in 2.4%. One patient with vocal cord palsy also suffered from severe dysphagia. One patient (0.8%) did not tolerate extra stimulation with magnet due to a prolonged spasm in his throat. The extra added benefit of vagus stimulation in one patient was a significant reduction of previously regular severe headaches. Conclusion: Vagus nerve stimulation is an appropriate treatment for patients with drug-resistant epilepsy who are not candidates for focal resective surgery. Implantation of the vagus nerve stimulator is a relatively safe operative procedure.

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