Impact of EMG Changes in Continuous Vagal Nerve Monitoring in High-Risk Endocrine Neck SurgeryReport as inadecuate




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World Journal of Surgery

, Volume 40, Issue 3, pp 672–680

First Online: 17 December 2015

Abstract

BackgroundContinuous vagal intraoperative neuromonitoring CIONM of the recurrent laryngeal nerve RLN may reduce the risk of RLN lesions during high-risk endocrine neck surgery such as operation for large goiter potentially requiring transsternal surgery, advanced thyroid cancer, and recurrence.

MethodsFifty-five consecutive patients 41 female, median age 61 years, 87 nerves at risk underwent high-risk endocrine neck surgery.
CIONM was performed using the commercially available NIM-Response 3.0 nerve monitoring system with automatic periodic stimulation APS and matching endotracheal tube electrodes Medtronic Inc

All CIONM events decreased amplitude-increased latency were recorded.

ResultsAPS malfunction occurred on three sides 3 %.
A total of 138 CIONM events were registered on 61 sides.
Of 138, 47 34 % events were assessed as imminent 13 events or potentially imminent 34 events lesions, whereas 91 66 % were classified as artifacts.
Loss of signal was observed in seven patients.
Actions to restore the CIONM baseline were undertaken in 58-138 42 % events with a median 60 s required per action.
Four RLN palsies 3 transient, 1 permanent occurred: one in case of CIONM malfunction, two sudden without any significant previous CIONM event, and one without any CIONM event.
The APS vagus electrode led to temporary damage to the vagus nerve in two patients.

ConclusionsCIONM may prevent RLN palsies by timely recognition of imminent nerve lesions.
In high-risk endocrine neck surgery, CIONM may, however, be limited in its utility by system malfunction, direct harm to the vagus nerve, and particularly, inability to indicate RLN lesions ahead in time.

Michael Brauckhoff: Deceased.

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Author: Katrin Brauckhoff - Renate Vik - Lorentz Sandvik - John-Helge Heimdal - Turid Aas - Martin Biermann - Michael Brauckhoff

Source: https://link.springer.com/article/10.1007/s00268-015-3368-y



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