Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury

Authors

  • Rick Schneider MD,

    Corresponding author
    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
    • Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. E-mail: rick.schneider@uk-halle.de

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    • The first 2 authors contributed equally to this work.

  • Gregory W. Randolph MD,

    1. Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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    • The first 2 authors contributed equally to this work.

  • Carsten Sekulla PhD,

    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Eimear Phelan MD,

    1. Department of Otolaryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
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  • Phuong Nguyen Thanh MD,

    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Michael Bucher MD,

    1. Department of Anesthesiology and Intensive Care Medicine, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Andreas Machens MD,

    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Henning Dralle MD,

    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Kerstin Lorenz MD

    1. Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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  • Disclosure statement: H. Dralle was remunerated for giving lectures on intraoperative nerve monitoring and G.W. Randolph received financial compensation for providing legal expert testimony. All other authors have nothing to declare.

Abstract

Background

Conventional intraoperative nerve monitoring, predicated on intermittent stimulation, can predict recurrent laryngeal nerve (RLN) palsy only after the damage has been done.

Methods

Fifty-two patients (52 nerves at risk) who underwent continuous intraoperative nerve monitoring (CIONM) for thyroid surgery via vagus nerve stimulation had their electromyographic (EMG) tracings recorded and correlated with surgical maneuvers and postoperative RLN function.

Results

There was 1 imminent loss of signal (LOS) with intraoperative signal recovery and there were 4 losses of signal with corresponding unilateral transient RLN palsy. When EMG amplitude decreased >50% and EMG latency increased >10%, LOS and postoperative RLN palsy were noted in 4 of 8 patients (50%) who had multiple combined events. In 9 of 13 patients (70%) who developed adverse EMG changes, modification of the causative surgical maneuver resulted in recovery of those EMG changes and aversion of impending RLN palsy.

Conclusion

CIONM reliably signaled impending nerve injury, enabling immediate corrective action. © 2012 Wiley Periodicals, Inc. Head Neck, 35: 1591–1598, 2013

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