Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Issue 11 (20th November 2012)

• Record Type: Journal Article
• Authors: Schneider, Rick; Randolph, Gregory W.; Sekulla, Carsten; Phelan, Eimear; Thanh, Phuong Nguyen; Bucher, Michael; Machens, Andreas; Dralle, Henning; Lorenz, Kerstin
• Is Part Of: Head & neck. Volume 35:Issue 11(2013:Nov.)
• Page Start: 1591
• Page End: 1598
• Publication Date: 2012-11-20
• Subjects: Head -- Diseases -- Periodicals; Neck -- Diseases -- Periodicals; Head -- Periodicals; Neck -- Periodicals; Face -- Periodicals; 617.51059
• DOI: 10.1002/hed.23187
• Languages: English
• ISSNs: 1043-3074

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hed23187-sec-0001" sec-type="section"> <title>Background</title> <p>Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done.</p> </sec> <sec id="hed23187-sec-0002" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="hed23187-sec-0003" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="hed23187-sec-0004" sec-type="section"> <title>Conclusion</title> <p>CIONM reliably signaled impending nerve injury, enabling immediate corrective action. © 2012 Wiley Periodicals, Inc. <italic>Head Neck</italic>, <bold>35</bold>: 1591–1598, 2013</p> </sec> </abstract>