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Published on: October 24, 2025
339
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
Summary
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.
- 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.
