Transcranial motor-evoked potentials of laryngeal muscles for intraoperative neuromonitoring of the vagus nerve during thyroid surgery

Ichino, Takashi; Tanaka, Satoshi; Tanaka, Ryusuke; Tanaka, N; Ishida, Takashi; Sugiyama, Yuki; Kawamata, Mikito

doi:10.1007/s00540-018-2601-x

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…The study provided available data on sensitivity and specificity. The bivariate analysis's findings are shown in Figure 5, with the study's overall sensitivities and specificities for ACSS being 71% and 98%, respectively (Ichino et al (2019)). 24.2% and 99.6%, respectively, were the combined positive and negative prognostic ratings.…”

Section: Intraoperative Neuromonitoring (Ionm) Sensitivity and Specif...mentioning

confidence: 94%

Determinants influencing intraoperative neuromonitoring quality during cervical spine treatment: A systematic review

Borges,

Panda,

Jayaraman

et al. 2024

Multidiscip. Rev.

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The functional integrity of the nervous system is monitored using a method known as Intraoperative Neuromonitoring (IONM) during surgical operations. Utilizing devices positioned on the patient's skin or within their muscles, IONM normally entails monitoring the electrical activity of nerves or muscles. The surgical technique used during the cervical spine treatment can influence the quality of IONM. Surgeons who are experienced in IONM and have a good understanding of the anatomy and physiology of the cervical spine are more likely to obtain accurate and reliable IONM signals. The signals are transmitted to a monitoring system that provides real-time feedback to the surgical team. This feedback can alert the team to potential nerve damage, allowing them to make adjustments to the surgical technique or take other steps to protect the nerves. Patient factors such as age, medical history, and comorbidities can influence the quality of IONM. For instance, patients with pre-existing neurological conditions or those who are elderly may have a higher risk of neurological damage during the surgery, which can affect the quality of IONM. The use of IONM for Anterior Cervical Spinal Surgery (ACSS) has been widely researched across a number of medical reference sources. Research on behind cervical surgery were neglected to take into consideration.

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Section: Intraoperative Neuromonitoring (Ionm) Sensitivity and Specif...mentioning

confidence: 94%

Determinants influencing intraoperative neuromonitoring quality during cervical spine treatment: A systematic review

Borges,

Panda,

Jayaraman

et al. 2024

Multidiscip. Rev.

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confidence: 89%

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2019

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We would like to thank the readers for their insightful comments on our recent study [1]. We agree that it is important to recognize the risk of bite injuries during vagal motorevoked potential (MEP) monitoring. In our study, we found that reliable vagal MEPs induced by transcranial electrical stimulation (TES) were obtained at a stimulation intensity of approximately 300 V with 3 or more pulses under reversal of the neuromuscular block. There was no remarkable bite injury in the postoperative period. However, TES-induced muscle responses in the temporal and mandibular regions, which potentially cause bite injuries, were observed in a small number of subjects. Therefore, since bite injuries may occur during vagal MEP recording with increasing stimulus intensity, we should pay attention to such complications.Reliable MEPs at the extremities could be obtained under partial neuromuscular block. However, sensitivity to muscle relaxant drugs [2] and stimulation thresholds to induce MEP may be different depending on the muscles. At present, it is not clear how the neuromuscular blockade affects the vagal MEPs. It is important to consider the balance between the benefit of vagal MEP monitoring for assessing functional integrity of the motor pathways and the risks associated with TES. Further studies are necessary to clarify the influence of neuromuscular block on vagal MEPs.

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“…To avoid the placement of a vagal stimulation electrode during endoscopic thyroid surgery, transcutaneous vagal nerve stimulation was evaluated and considered not feasible in the experimental setup [33]. Moreover, transcranial motor-evoked potentials of laryngeal muscles were proposed as a feasible alternative for cIONM during thyroid surgery [34]. "LAR-cIONM," a recently described method, which requires endotracheal surface electrodes for both cIONM signal stimulation and -recognition, stands out from these alternative techniques as a very promising example.…”

Section: From Intermittent To Continuous Ionm: Real-time Evaluation Of Rln Function During Surgical Maneuversmentioning

confidence: 99%

Continuous Intraoperative Recurrent Laryngeal Nerve Monitoring: Techniques, Applications, and Controversies

Staubitz

Musholt

2021

Curr Otorhinolaryngol Rep

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Purpose of Review Purpose of the present review is to illustrate the current state of the art concerning continuous intraoperative recurrent laryngeal nerve monitoring (cIONM) for thyroid surgery. Recent Findings cIONM potentially leads to an improved postoperative vocal cord palsy rate, compared to the intermittent technique. There are currently two main approaches for cIONM: either conventional cIONM based on vagal nerve stimulation or experimental methods, which do not require the positioning of a vagal nerve electrode. One of these methods is the recently described technique “LAR-cIONM,” which utilizes the laryngeal adductor reflex. Summary cIONM represents an advancement of intermittent nerve monitoring, which allows for an immediate reaction to signal changes. Threshold values and guidelines to prevent recurrent laryngeal nerve palsy were validated for the direct stimulation of the vagal nerve and require verification for alterative cIONM methods, including LAR-cIONM.

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Transcranial motor-evoked potentials of laryngeal muscles for intraoperative neuromonitoring of the vagus nerve during thyroid surgery

Cited by 6 publications

References 27 publications

Determinants influencing intraoperative neuromonitoring quality during cervical spine treatment: A systematic review

Determinants influencing intraoperative neuromonitoring quality during cervical spine treatment: A systematic review

Reply to the letter to the editor

Continuous Intraoperative Recurrent Laryngeal Nerve Monitoring: Techniques, Applications, and Controversies

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