Seeing Is Not Believing: Intraoperative Nerve Monitoring (IONM) in the Thyroid Surgery

Area of Science:

• Surgical Neurology
• Otolaryngology
• Endocrine Surgery

Background:

• Thyroid surgery aims to preserve recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN) for voice function.
• Anatomical integrity of nerves does not guarantee functional integrity post-surgery.
• Neural injuries during thyroidectomy can be subtle and unpredictable, even with meticulous dissection.

Purpose of the Study:

• To critically evaluate the true usefulness of intraoperative nerve monitoring (IONM) in thyroid surgery.
• To elaborate on the optimal practices for implementing IONM.
• To present a comprehensive literature review on IONM's role and effectiveness.

Main Methods:

• Review of existing randomized studies, systematic reviews, and meta-analyses on IONM.
• Analysis of the evolution from intermittent to continuous IONM techniques.
• Critical assessment of literature regarding IONM's impact on nerve identification and functional impairment detection.

Main Results:

• IONM is designed to assist in nerve identification and detect functional impairment during thyroid surgery.
• Despite technological advancements, clinical equipoise persists regarding IONM's definitive utility and cost-effectiveness.
• Evidence from numerous studies remains inconclusive for widespread consensus on IONM's benefits.

Conclusions:

• The clinical utility and cost-effectiveness of IONM in thyroid surgery require further investigation.
• Optimal practice guidelines for IONM are essential to maximize its potential benefits.
• A balanced perspective, considering both support and criticism, is necessary for understanding IONM's role.