Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury

Background Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done. Methods Fifty‐two patients (52 nerves at risk) who underwent continuous intraoperative nerve monitoring (CIONM) for...

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Bibliographic Details
Published in:Head & neck 2013-11, Vol.35 (11), p.1591-1598
Main Authors: Schneider, Rick, Randolph, Gregory W., Sekulla, Carsten, Phelan, Eimear, Thanh, Phuong Nguyen, Bucher, Michael, Machens, Andreas, Dralle, Henning, Lorenz, Kerstin
Format: Article
Language:English
Subjects:
Adult
Aged
APS electrode
Cohort Studies
Continuous intraoperative nerve monitoring
Electric Stimulation - methods
Electromyography - methods
Female
Follow-Up Studies
Humans
loss of signal
Male
Middle Aged
Monitoring, Intraoperative - methods
Recurrent Laryngeal Nerve Injuries - prevention & control
recurrent laryngeal nerve injury
Retrospective Studies
Risk Assessment
Thyroidectomy - adverse effects
Thyroidectomy - methods
Treatment Outcome
vagal electrode
Vagus Nerve
vagus nerve stimulation
vocal cord palsy
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Summary:Background Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done. Methods Fifty‐two patients (52 nerves at risk) who underwent continuous intraoperative nerve monitoring (CIONM) for thyroid surgery via vagus nerve stimulation had their electromyographic (EMG) tracings recorded and correlated with surgical maneuvers and postoperative RLN function. Results There was 1 imminent loss of signal (LOS) with intraoperative signal recovery and there were 4 losses of signal with corresponding unilateral transient RLN palsy. When EMG amplitude decreased >50% and EMG latency increased >10%, LOS and postoperative RLN palsy were noted in 4 of 8 patients (50%) who had multiple combined events. In 9 of 13 patients (70%) who developed adverse EMG changes, modification of the causative surgical maneuver resulted in recovery of those EMG changes and aversion of impending RLN palsy. Conclusion CIONM reliably signaled impending nerve injury, enabling immediate corrective action. © 2012 Wiley Periodicals, Inc. Head Neck, 35: 1591–1598, 2013
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.23187