Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience

Mourad, Moustafa; Kadakia, Sameep; Jategaonkar, Ameya A.; Gordin, Eli; Ducic, Yadranko

doi:10.1002/hed.24812

Cited by 7 publications

(3 citation statements)

References 14 publications

(28 reference statements)

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“…Preoperative planning: If this is the patient's first neck surgery, we do not use the nerve monitor as it has not been shown to reduce nerve injury ( 31 ). The only instance where we use the nerve monitor is in the reoperative cervical procedure where extensive scarring is anticipated or when one of the recurrent laryngeal nerves has been damaged previously.…”

Section: Indications For Treatmentmentioning

confidence: 99%

Intraoperative Decision-Making and Technical Aspects of Parathyroidectomy in Young Patients With MEN1 Related Hyperparathyroidism

et al. 2018

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One in 5,000 to 1 in 50,000 births have multiple endocrine neoplasia type 1 (MEN1). MEN1 is a hereditary syndrome clinically defined by the presence of two of the following endocrine tumors in the same patient: parathyroid adenomas, entero-pancreatic endocrine tumors and pituitary tumors. Most commonly, patients with MEN1 manifest primarily with signs and symptoms linked to primary hyperparathyroidism. By age 50, it is estimated that 100% of patients with MEN1 will have been diagnosed with primary hyperparathyroidism. These patients will need to undergo resection of their hyperfunctioning glands, however there is no clear consensus on which procedure to perform and when to perform it in these patients. In this original study we describe and explain the rational of our peri-operative approach and management at MD Anderson Cancer Center of MEN1 patients with hyperparathyroidism. This protocol includes preoperative evaluation, intraoperative decision-making and detailed surgical technique adopted for these patients' care. Additionally we review follow-up and disease management in instances of recurrent primary hyperparathyroidism in patients with MEN1 syndrome.

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Section: Indications For Treatmentmentioning

confidence: 99%

Intraoperative Decision-Making and Technical Aspects of Parathyroidectomy in Young Patients With MEN1 Related Hyperparathyroidism

et al. 2018

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“…Prior studies have examined the use of IONM during parathyroidectomy—mainly focusing on parathyroidectomy for primary hyperparathyroidism. Again, these found no significant difference between the use of IONM vs no monitoring, suggesting that the use of IONM may not yield any additional benefit in preventing nerve injury 3 . Despite these results, the thought persists that the routine use of IONM may reduce pitfalls and provide guidance for surgeons in difficult cases, reoperations, and high‐risk patients 4 .…”

Section: Introductionmentioning

confidence: 97%

“…Again, these found no significant difference between the use of IONM vs no monitoring, suggesting that the use of IONM may not yield any additional benefit in preventing nerve injury. 3 Despite these results, the thought persists that the routine use of IONM may reduce pitfalls and provide guidance for surgeons in difficult cases, reoperations, and high-risk patients. 4 One could consider a surgery more difficult and complicated when all four parathyroid glands must be dissected and identified, rather than one gland only; such is the case when performing surgery for patients with secondary or tertiary hyperparathyroidism.…”

Section: Introductionmentioning

confidence: 99%

The utility of intraoperative nerve monitoring in secondary and tertiary Hyperparathyroid surgery

Dudley

Nezakatgoo

Rist

et al. 2021

Clinical Case Reports

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Objectives: Recurrent laryngeal nerve (RLN) injury is a well-known complication of parathyroid surgery. Despite ample data, there is still uncertainty about the role of intraoperative monitoring (IONM) in mitigating RLN damage. Study Design: A retrospective review. Methods: We included all patients presenting for total, subtotal, or completion parathyroidectomy at a tertiary referral hospital from 2013 to 2018. Information about demographics, previous neck surgery, perioperative data, pathology, and possible RLN injury was collected. Two groups were formed for analysis: IONM vs. nonmonitored (NM). Results: 105 patients underwent 107 surgeries with IONM utilized in 71 cases. The groups were similar in demographics, but significantly differed (all P < 0.05) in preincision parathyroid hormone level (IONM = 2091.44 vs NM = 1334.87), surgery type (IONM = 62.9% vs NM = 27.8% subtotal), and surgery length in minutes (IONM = 155.21 vs NM = 182.22). We observed six cases (6/71 = 8.45%) of persistent RLN complaints (three or more weeks postoperatively) and four cases (4/71 = 5.63%) of temporary complaints with the use of IONM compared with only one temporary complaint (1/36 = 2.78%) in unmonitored procedures (P = 0.129). Conclusions: These results suggest that the use of IONM does not provide a protective effect on the RLN in patients with secondary or tertiary hyperparathyroidism undergoing total, subtotal, or completion parathyroidectomy. Prospective, randomized studies with pre-and postoperative flexible laryngoscopy are needed to explore the use of IONM in this patient population further.

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Nerve Monitoring During Parathyroid Surgery

Pellitteri

Purdy

2022

Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery

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Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience

Abstract: Routine use of intraoperative nerve monitoring during parathyroid surgery may not yield any additional benefit in preventing injury to the RLN.

Cited by 7 publications

References 14 publications

Intraoperative Decision-Making and Technical Aspects of Parathyroidectomy in Young Patients With MEN1 Related Hyperparathyroidism

Intraoperative Decision-Making and Technical Aspects of Parathyroidectomy in Young Patients With MEN1 Related Hyperparathyroidism

The utility of intraoperative nerve monitoring in secondary and tertiary Hyperparathyroid surgery

Nerve Monitoring During Parathyroid Surgery

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