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Neck extension during thyroidectomy: effects on early postoperative cognitive function and optic nerve sheath

Başak Altıparmak1, Ahmet Pınarbaşı2, Melike Korkmaz Toker1

  • 1Department of Anesthesiology and Reanimation, Muğla Sıtkı Koçman University, Muğla, Türkiye.

BMC Anesthesiology
|December 1, 2025
PubMed
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Shoulder roll positioning during thyroidectomy is linked to a mild decline in postoperative cognitive function, as measured by lower Montreal Cognitive Assessment (MoCA) scores. Optic nerve sheath diameter (ONSD) did not show significant differences between groups.

Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Surgical Patient Positioning

Background:

  • Thyroidectomy often involves neck extension using a shoulder roll.
  • Excessive neck extension may compromise cerebral perfusion and increase intracranial pressure.
  • This can potentially lead to postoperative cognitive impairment.

Purpose of the Study:

  • To investigate the impact of shoulder-roll-assisted neck extension on cognitive outcomes after thyroidectomy.
  • To assess the effect of this positioning on optic nerve sheath diameter (ONSD).

Main Methods:

  • Patients undergoing thyroidectomy were randomized into a shoulder roll group or a control group.
  • The primary outcome was the Montreal Cognitive Assessment (MoCA) score at 6 hours postoperatively.
Keywords:
Cognitive functionNeck extensionOptic nerve sheath diameterPatient positioningPatient safetyThyroidectomy

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  • Secondary outcomes included ONSD and the degree of neck extension.

    • Main Results:

    • The shoulder roll group exhibited significantly lower postoperative MoCA scores compared to the control group (P < 0.001).
    • Neck extension was significantly greater in the shoulder roll group (126° ± 4.36°) versus the control group (116° ± 3.74°; P < 0.001).
    • While ONSD increased in both groups, no significant difference was found between them.

    Conclusions:

    • Shoulder roll positioning during thyroidectomy is associated with mild postoperative cognitive decline.
    • Greater neck extension occurred with shoulder roll use, but ONSD did not significantly differ between groups.