Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Dionigi, Gianlorenzo; Chiang, Feng‐Yu; Rausei, Stefano; Wu, Chien‐Ming; Boni, Luigi; Lee, Ka–Wo; Rovera, Francesca; Cantone, Giovanni; Bacuzzi, Alessandro

doi:10.1007/s00423-010-0693-3

Cited by 69 publications

(72 citation statements)

References 15 publications

(39 reference statements)

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“…During CEA, the surgeon cannot find a variant VN located medial or posterior to the carotid artery. Visual identification of the recurrent laryngeal nerve (RLN) during thyroid surgery is associated with lower rates of permanent RLN palsy and is considered the gold standard by many authors [12] [13] [14]. Jatzko et al reviewed 10 reports covering 12,211 thyroid operations and found a lower rate of RLN palsy in the patients with nerve identification than in those without nerve identification (2.7% vs 7.9% for temporary palsy and 1.2% vs 5.2% for permanent palsy) [14].…”

Section: Discussionmentioning

confidence: 99%

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

Tamaki¹,

Kubota²,

Node³

et al. 2017

OJMN

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Backgrounds: Injury to the vagus nerve or one of its branches during carotid endarterectomy can result in vocal fold paralysis but the exact mechanism of injury responsible for vocal fold paralysis after carotid endarterectomy is unclear. Aims: This study was performed to identify potential predictors of vagus nerve injury and obtain feedback by application of intraoperative continuous vagus nerve monitoring. Materials and Methods: Seventy-four patients undergoing carotid endarterectomy were enrolled. A new vagus nerve electrode was designed for less invasive continuous vagus nerve stimulation and monitoring of the vocal fold electromyogram without disturbing the surgical procedure. The device was rectangular (13 mm × 9 mm), with two small round electrodes set on a flexible silicon plate and tube. The electrode was fully implantable during carotid endarterectomy and was positioned at the most distal site of the vagus nerve by suturing to the connective tissue without nerve dissection. All patients underwent laryngoscopy to assess postoperative vocal fold and pharyngeal wall palsy at one week after carotid endarterectomy. Results: Sudden loss of the vocal fold electromyogram was noted in two patients (during plaque removal and during arterial wall suture in one each). In these two patients, incomplete vocal fold and pharyngeal palsy was confirmed by laryngoscopy. The cause of vagus nerve injury may have been traction at the time of distal internal carotid artery manipulation. The vocal fold electromyogram remained normal during the operation in the other 72 patients. However laryngoscopy revealed postoperative vocal fold and pharyngeal palsy in six patients. These findings suggested that delayed vagus nerve injury can occur after carotid endarterectomy. Conclusion: The continuous vagus nerve monitoring may be worthwhile for elucidating the mechanism of vagus nerve injury related to carotid endarterectomy.

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Section: Discussionmentioning

confidence: 99%

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

Tamaki¹,

Kubota²,

Node³

et al. 2017

OJMN

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“…Given the varying position of the VN, the C-IONM probe must also be highly versatile. The location of the VN in relation to the common carotid artery and internal jugular vein can be classified as anterior (A), posterior (P), posterior to the internal jugular vein (PJ), or posterior to the common carotid artery (PC) (17). Most (90%) VNs lie in the posterior region of the carotid sheath in the groove between these 2 vessels.…”

Section: Stimulation Probes For C-ionmmentioning

confidence: 99%

“…Most (90%) VNs lie in the posterior region of the carotid sheath in the groove between these 2 vessels. On both sides, the most common location of the VN is the P location followed by the PC (15%) and PJ (8%) locations (17). The highly variable location of the VN is yet another reason why a simpler C-IONM probe is needed (17).…”

Section: Stimulation Probes For C-ionmmentioning

confidence: 99%

Future Directions of Neural Monitoring in Thyroid Surgery

Kim

Liu

et al. 2017

J Endocr Surg

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Dissecting and identifying the recurrent laryngeal nerve (RLN) are considered routine procedures now that safe and effective methods have been established. Preventing RLN injury during thyroid surgery requires good visualization and exposure of the RLN, adequate knowledge of RLN anatomy, adequate surgical experience and training, and pre-and postoperative laryngoscopy. Whereas these requirements are widely accepted for routine thyroid surgery, new technical developments have emerged in the past 15 years. Literature show that both intermittent intraoperative neural monitoring (I-IONM) and continuous IONM (C-IONM) are recognized as effective techniques for RLN. The aim of this paper is to discuss advantages, limits and possible future directions for use of IONM and C-IONM in thyroid and parathyroid surgery.

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“…Additional research is warranted to confirm these results in larger groups of patients with advanced atrioventricular block. Finally, surgeon should be have perfect knowledge of the VN surgical anatomy that is the medial location of the common carotid artery (CCA) and anterolateral or lateral location of the internal jugular vein (IJV) are the most common configurations (36). Thera are few cases of medial IJV position (36).…”

Section: Safety Of C-ionm Electrodesmentioning

confidence: 99%

“…Finally, surgeon should be have perfect knowledge of the VN surgical anatomy that is the medial location of the common carotid artery (CCA) and anterolateral or lateral location of the internal jugular vein (IJV) are the most common configurations (36). Thera are few cases of medial IJV position (36). Tortuosity, kinking, or coiling of the carotid arteries are frequent with advancing age.…”

Section: Safety Of C-ionm Electrodesmentioning

confidence: 99%

Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure

et al. 2018

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Literature on intraoperative neuro monitoring (IONM) during endocrine surgery have increased over recent years. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. Neuromonitoring techniques are currently considered safe technique and technology; however, albeit sporadically, have been reported some complications and related side effects using such methods. The complications described can be related to the electrodes positioned at the larynx, at the obstruction of the endotracheal tube, the drugs used for anesthesia and the effects of electrical stimulation on nerve structures and systemic levels. This review will explore the safety issues of IONM to improve the outcomes among patients undergoing monitored thyroidectomy.

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Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

Abstract: A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM.

Cited by 69 publications

References 15 publications

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

Continuous Vagus Nerve Monitoring during Carotid Endarterectomy

Future Directions of Neural Monitoring in Thyroid Surgery

Improving Safety of Neural Monitoring in Thyroid Surgery: Educational Considerations in Learning New Procedure

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