Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement

Abstract

Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problemsolving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.

Modification of the Surgical Strategy for the Dissection of the Recurrent Laryngeal Nerve Using Continuous Intraoperative Nerve Monitoring

“…A recent meta-analysis and a randomized study Paper show benefit in reducing transient RLNP in complex cases [6,7]. Another advantage of I-IONM is the prevention of bilateral RLNP, with implementation of strict operative procedures for two-staged thyroidectomy [8] and standardized procedures for I-IONM [9]. Continuous intraoperative neuromonitoring (C-IONM) is a more recent technique and represents the potential for incremental improvement, potentially enabling the surgeon to react before irreversible damage to the RLN occurs [10,11].…”

Intraoperative Vagus Nerve Monitoring: A Transnasal Technique during Skull Base Surgery

“…Malposition of the electrode at the glottis is the most common cause of recurrent laryngeal IONM failure. 2 In this series, there were no events of tube movement resulting in failure of IONM during surgery.…”

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

“…The strategies to be compared were neuromonitoring in addition to routine searching of the RLN versus routine searching of RLN according to the guidelines proposed by the International Neural Monitoring Study Group (4). These guidelines include the use of a tracheal tube with an embedded electrode that acts as a receiver, an electric stimulator and an electromyography monitor that records effector muscle activity under stimulation.…”

“…Recently, neuromonitoring has been recommended as a novel alternative to further decrease the rate of RLN palsy (4). Two published meta-analyses did not demonstrate a statistically significant difference in the rate of RLN injury (5,6).…”