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Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
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Continuous Intraoperative Neuromonitoring in Thyroid Surgery.

Flavia Angeletti1, Petra B Musholt2, Thomas J Musholt3

  • 1Clinic of General, Visceral and Transplantation Surgery, University Medical Center, Gutenberg University Mainz, Mainz, Germany.

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Summary

Intermittent intraoperative neuromonitoring (I-IONM) offers limited benefits in thyroid surgery, mainly aiding strategy changes during bilateral resections. Continuous monitoring (C-IONM) shows promise for real-time nerve protection.

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Surgical Technology

Background:

  • Intermittent intraoperative neuromonitoring (I-IONM) has evolved with improved devices and standardized guidelines.
  • Despite advancements, I-IONM's benefit over visual identification for recurrent laryngeal nerve (RLN) paralysis in primary thyroidectomy is not definitively proven.
  • Current I-IONM cannot predict impending nerve damage during dissection.

Purpose of the Study:

  • To evaluate the evolving role and limitations of intermittent intraoperative neuromonitoring (I-IONM) in thyroid surgery.
  • To highlight the potential advantages of continuous intraoperative neuromonitoring (C-IONM) for real-time nerve protection.
  • To discuss the current benefits and future directions of neuromonitoring in thyroidectomies.

Main Methods:

  • Review of technological advancements in neuromonitoring devices, including endotracheal tube electrodes.
  • Analysis of surgical society recommendations and guidelines for I-IONM application.
  • Comparison of I-IONM efficacy against visual identification and the potential of C-IONM.

Main Results:

  • I-IONM primarily assists in strategy modification for bilateral thyroidectomies when a "loss of signal" occurs.
  • A significant benefit of I-IONM compared to visual identification alone has not been demonstrated due to low rates of permanent RLN paralysis.
  • Continuous intraoperative neuromonitoring (C-IONM) shows preliminary promise for enabling surgeons to react to nerve compromise before irreversible damage.

Conclusions:

  • While I-IONM has limitations in predicting nerve damage, it remains valuable for specific surgical scenarios like bilateral resections.
  • Continuous intraoperative neuromonitoring (C-IONM) represents a significant advancement, offering potential for proactive recurrent laryngeal nerve (RLN) protection.
  • Further research and data are needed to fully establish the clinical utility of C-IONM in thyroid surgery.