Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring

Netto, Irene de Pedro; Vartarian, Jose Guilherme; Ferraz, Pablo Rodrigo Rocha; Salgado, Priscila; Azevedo, Juliana Bueno Meirelles de; Toledo, Ronaldo Nunes; Testa, José Ricardo Gurgel; Carrara-de-Angelis, Elisabete; Kowalski, Luiz Paulo

doi:10.1590/s1516-31802007000300011

Cited by 33 publications

(14 citation statements)

References 17 publications

(43 reference statements)

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“…Another related study by Netto Ide et al (2007) also claimed that the use of IONM did not decrease VC paralysis in comparison with a control group who did not undergo neuromonitoring. This study used IONM as a means to identify the RLN.…”

Section: Discussionmentioning

confidence: 94%

Surface Electrode Recurrent Laryngeal Nerve Monitoring During Thyroid Surgery: Normative Values

Choby

Hollenbeak²,

Johnson

et al. 2010

Journal of Clinical Neurophysiology

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The objective of this study was to determine the normative values for threshold stimulation of the recurrent laryngeal nerve (RLN) using intraoperative neuromonitoring before and after thyroidectomy. Eighty patients with 111 at-risk nerves underwent thyroid surgery by a single surgical team at an academic medical center in central Pennsylvania during this retrospective study. RLN threshold measurements were taken before and after resection to determine the minimum current needed to stimulate the RLN. Risk of paresis was modeled using logistic regression, and risk was quantified using adjusted odds ratios. The results showed the average minimum current required for stimulation of the RLN before resection was 0.50 mA. The average RLN minimum threshold level after resection was 0.47 mA. The average difference in pre- and postresection RLN threshold current was -0.03 mA. The preresection RLN threshold level (P = 0.31), the postresection RLN threshold level (P = 0.82), and the difference in the pre- and postresection RLN threshold level (P = 0.16) all did not have a statistically significant effect on paresis. No other covariates had a significant association with paresis.

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Section: Discussionmentioning

confidence: 94%

Surface Electrode Recurrent Laryngeal Nerve Monitoring During Thyroid Surgery: Normative Values

Choby

Hollenbeak²,

Johnson

et al. 2010

Journal of Clinical Neurophysiology

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“…The characteristics of the 43 selected studies are shown in Table I through Table III 8–51. Baseline characteristics are provided in Table IV.…”

Section: Resultsmentioning

confidence: 99%

Tissue factor pathway inhibitor-2 as a frequently silenced tumor suppressor gene in hepatocellular carcinoma

Wong

Lee

et al. 2007

Hepatology

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In HCC, inactivation of tumor suppressor genes plays a significant role in carcinogenesis. Apart from deletions and mutations, growing evidence has indicated that epigenetic alterations including aberrant promoter methylation and histone deacetylation are also implicated in inactivation of tumor suppressor genes. The goal of this study was to identify epigenetically silenced candidate tumor suppressor genes in human HCC by comparing the changes in oligonucleotide microarray gene expression profiles in HCC cell lines upon pharmacological treatment with the demethylating agent 5-Aza-2 -deoxycytidine (5-AzadC). By analyzing the gene expression profiles, we selected tissue factor pathway inhibitor-2 (TFPI-2), a Kunitz-type serine protease inhibitor, for validation and further characterization. Our results showed that TFPI-2 was frequently silenced in human HCC and HCC cell lines. TFPI-2 was significantly underexpressed in approximately 90% of primary HCCs when compared with their corresponding nontumorous livers. TFPI-2 promoter methylation was detected in 80% of HCC cell lines and 47% of human HCCs and was accompanied by reduced TFPI-2 messenger RNA expression. In addition, TFPI-2 expression in HCC cell lines can be robustly restored by combined treatment with 5-Aza-dC and histone deacetylase inhibitor trichostatin A. These findings indicate that TFPI-2 is frequently silenced in human HCC via epigenetic alterations, including promoter methylation and histone deacetylation. Moreover, ectopic overexpression of TFPI-2 significantly suppressed the proliferation and invasiveness of HCC cells. Conclusion: Our findings suggest that TFPI-2 is a candidate tumor suppressor gene in human HCC. (HEPATOLOGY 2007;45:1129-1138

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“…Despite widespread and increasing use of this technology, true vocal cord palsy and paralysis as a result of iatrogenic injury to the RLN persist. The overall incidence of temporary injury is 2-8 %, while that for permanent injury is between 0.5 and 3 % [8][9][10][11][12].…”

Section: Historymentioning

confidence: 99%

Intraoperative Neuromonitoring in Thyroid Surgery: A Systematic Review

Malik

Linos

2016

World j. surg.

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This study aimed to assess the efficacy of intraoperative neurophysiologic monitoring (IONM) in preventing recurrent laryngeal nerve palsy (RLNP) during thyroid surgery. When IONM results in false positives, it seeks to evaluate contributing factors. A systematic review was conducted gauging the predictive power of neuromonitoring in determining RLN function intraoperatively, its reductions of temporary and permanent RLNP rates, and surgeons' response to the technology. MEDLINE, EMBASE, and PubMed were searched for RLN monitoring in thyroid surgery following a set of inclusion/exclusion criteria. Seventeen studies comparing thyroid surgery with and without IONM were reviewed, including 30,926 patients. Selected studies were pooled to gage the predictive power. Mean specificity of IONM in identifying functional nerves was 90.24 % among 7366 nerves at risk (NAR). However, mean positive predictive power (PPP) was low, and both specificity and PPP varied substantially when stratified by risk levels. Among the pooled studies focusing on IONM efficacy-there were 44,575 NAR, of which (57.98 %) were operated on with IONM and 18,732 (42.02 %) without (control). The rates of overall RLNP per NAR were 3.18 and 3.83 % for the IONM group and control, respectively. There is no statistically significant difference between IONM and control, a conclusion supported by qualitative analysis from many individual studies. IONM is not recommended as the standard of care for thyroidectomies. Low PPP of IONM and complications associated with IONM-assisted thyroidectomies may be attributed to either the absence of a standardized negative-signal cutoff value or injury from intubation.

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Vocal fold immobility after thyroidectomy with intraoperative recurrent laryngeal nerve monitoring

Cited by 33 publications

References 17 publications

Surface Electrode Recurrent Laryngeal Nerve Monitoring During Thyroid Surgery: Normative Values

Surface Electrode Recurrent Laryngeal Nerve Monitoring During Thyroid Surgery: Normative Values

Tissue factor pathway inhibitor-2 as a frequently silenced tumor suppressor gene in hepatocellular carcinoma

Intraoperative Neuromonitoring in Thyroid Surgery: A Systematic Review

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