Abstract：
BACKGROUND:Continuous vagal intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve (RLN) may reduce the risk of RLN lesions during high-risk endocrine neck surgery such as operation for large goiter potentially requiring transsternal surgery, advanced thyroid cancer, and recurrence. METHODS:Fifty-five consecutive patients (41 female, median age 61 years, 87 nerves at risk) underwent high-risk endocrine neck surgery. CIONM was performed using the commercially available NIM-Response 3.0 nerve monitoring system with automatic periodic stimulation (APS) and matching endotracheal tube electrodes (Medtronic Inc.). All CIONM events (decreased amplitude/increased latency) were recorded. RESULTS:APS malfunction occurred on three sides (3%). A total of 138 CIONM events were registered on 61 sides. Of 138, 47 (34%) events were assessed as imminent (13 events) or potentially imminent (34 events) lesions, whereas 91 (66%) were classified as artifacts. Loss of signal was observed in seven patients. Actions to restore the CIONM baseline were undertaken in 58/138 (42%) events with a median 60 s required per action. Four RLN palsies (3 transient, 1 permanent) occurred: one in case of CIONM malfunction, two sudden without any significant previous CIONM event, and one without any CIONM event. The APS vagus electrode led to temporary damage to the vagus nerve in two patients. CONCLUSIONS:CIONM may prevent RLN palsies by timely recognition of imminent nerve lesions. In high-risk endocrine neck surgery, CIONM may, however, be limited in its utility by system malfunction, direct harm to the vagus nerve, and particularly, inability to indicate RLN lesions ahead in time.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Brauckhoff K,Vik R,Sandvik L,Heimdal JH,Aas T,Biermann M,Brauckhoff Mdoi
10.1007/s00268-015-3368-ysubject
Has Abstractpub_date
2016-03-01 00:00:00pages
672-80issue
3eissn
0364-2313issn
1432-2323pii
10.1007/s00268-015-3368-yjournal_volume
40pub_type
杂志文章abstract：:The principles of minimally invasive parathyroidectomy include the successful preoperative localization of a solitary adenoma, a targeted operative approach that does not disturb the normal parathyroid glands, and intraoperative confirmation of excision of all hypersecreting parathyroid tissue. By providing real-time ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
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journal_title：World journal of surgery
pub_type： 杂志文章,评审
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journal_title：World journal of surgery
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journal_title：World journal of surgery
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pub_type： 杂志文章
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journal_title：World journal of surgery
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更新日期：2011-02-01 00:00:00
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pub_type： 杂志文章,随机对照试验
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更新日期：2008-05-01 00:00:00
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pub_type： 杂志文章,meta分析,评审
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pub_type： 临床试验,杂志文章
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更新日期：1996-01-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
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更新日期：2000-05-01 00:00:00
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journal_title：World journal of surgery
pub_type： 杂志文章
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更新日期：2015-07-01 00:00:00
