Intraoperative Neuromonitoring in Thyroid and Parathyroid Surgery

Area of Science:

• Otolaryngology
• Neurosurgery
• Surgical Innovation

Background:

• Recurrent laryngeal nerve (RLN) injury is a known risk in thyroid and parathyroid surgery.
• External branch of the superior laryngeal nerve (EBSLN) damage can be subtle and difficult to diagnose, impacting voice pitch.
• Intraoperative neuromonitoring (IONM) is gaining traction to improve nerve identification and safety.

Purpose of the Study:

• To review the rationale, efficacy, and safety of using IONM in thyroid and parathyroid surgery.
• To address skepticism regarding IONM's effectiveness in preventing nerve injuries.
• To highlight the benefits of IONM in recognizing, verifying, and localizing laryngeal nerves.

Main Methods:

• Overview of clinical usage and existing literature on IONM in endocrine surgery.
• Discussion of IONM's role in facilitating nerve identification and functional assessment.
• Analysis of IONM's impact on surgical outcomes and patient safety.

Main Results:

• IONM facilitates recognition and functional verification of RLN and EBSLN.
• The technique helps localize nerve injury sites and provides postsurgical feedback.
• IONM has demonstrated success in reducing bilateral laryngeal paralysis rates.

Conclusions:

• IONM is recommended for all thyroidectomies.
• IONM is advised for high-risk parathyroidectomies to enhance patient safety.
• IONM improves the safety profile for surgical patients undergoing laryngeal procedures.