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Updated: Oct 22, 2025
Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model
Published on: February 11, 2019
Laryngeal Neural Monitoring during Pediatric Thyroid Cancer Surgery-Is Transcartilage Recording a Preferable Method?
Tzu-Yen Huang1,2, Hoon-Yub Kim3, Gianlorenzo Dionigi4,5
1International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
Transcartilage intraoperative neuromonitoring (TC-IONM) offers superior EMG signal quality for pediatric thyroid surgery compared to endotracheal tube methods. This technique enhances recurrent laryngeal nerve dissection, proving effective for pediatric thyroid cancer.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Neurosurgery
Background:
- Intraoperative neuromonitoring (IONM) is crucial for thyroidectomies to preserve recurrent laryngeal nerve function.
- Transcartilage IONM (TC-IONM) has shown promise in adults, but its use in pediatric thyroid surgery is unreported.
- Pediatric thyroid cancer surgery requires precise nerve dissection, making effective IONM essential.
Purpose of the Study:
- To evaluate the feasibility and benefits of TC-IONM in pediatric patients undergoing thyroidectomy.
- To compare the performance of TC-IONM versus endotracheal tube IONM (ET-IONM) in this population.
- To assess the impact of TC-IONM on recurrent laryngeal nerve dissection during pediatric thyroid surgery.
Main Methods:
- Retrospective single-center study of 33 pediatric patients who underwent IONM-assisted thyroidectomy.
- Comparison of demographic data, laryngeal examinations, and IONM stimulation parameters (L1-V1-R1-R2-V2-L2) between TC-IONM and ET-IONM.
- Analysis of electromyography (EMG) amplitude, signal stability (V1/V2 correlation), signal quality, and R1-R2p change.
Main Results:
- In 15 cancer patients, TC-IONM demonstrated significantly higher EMG amplitude (p < 0.001), improved signal stability (r = 0.955 vs. 0.484, p = 0.004), and better signal quality (p = 0.005) compared to ET-IONM.
- TC-IONM also showed a significantly lower change in R1-R2p (7.1% vs. 37.5%, p = 0.049) in cancer patients.
- In 18 benign cases, TC-IONM yielded significantly higher EMG amplitude (p < 0.001) and signal stability (r = 0.945 vs. 0.746, p = 0.0324).
Conclusions:
- TC-IONM is the first reported method for neuromonitoring in pediatric thyroid surgery.
- TC-IONM provides superior EMG signal amplitude, stability, and quality compared to ET-IONM in pediatric thyroidectomies.
- TC-IONM is a feasible, effective, and preferable method for monitored thyroidectomy, especially in pediatric thyroid cancer cases.
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