Background: Systematic studies of intermittent intraoperative neuromonitoring (IONM) have shown that IONM enhances recurrent laryngeal nerve (RLN) identification via functional assessment, but does not significantly reduce rates of vocal cord (VC) paralysis (VCP). The reliability of functional nerve assessment depends on the preoperative integrity of VC mobility. The present study was therefore performed to analyze the validity of IONM in patients with pre-existing VC paralysis.
Methods: Of 8,128 patients, 285 (3.5 %) with preoperative VCP underwent thyroid surgery using standardized IONM of the RLN and vagus nerves (VNs). VC function was assessed by pre- and postoperative direct videolaryngoscopy. Quantitative parameters of IONM in patients with VCP were compared with IONM in patients with intact VC function. Clinical symptoms and surgical outcomes of patients with pre-existing VCP were analyzed.
Results: A total of 244 patients revealed negative, and 41 revealed positive IONM on the side of the VCP. VCP with positive IONM revealed significantly lower amplitudes of VN and RLN than intact VN (p = 0.010) and RLN (p = 0.011). Symptoms of patients with VCP included hoarseness (25 %), dyspnea (29 %), stridor (13 %), and dysphagia (13 %); 13 % were asymptomatic. New VCP occurred in five patients, ten needed tracheostomy for various reasons, and one patient died.
Conclusions: Patients with pre-existing VCP revealed significantly reduced amplitude of ipsilateral VN and RLN, indicating retained nerve conductivity despite VC immobility. Preoperative laryngoscopy is therefore indispensable for reliable IONM and risk assessment, even in patients without voice abnormalities.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00268-013-2402-1 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Preoperative and intraoperative neuromonitoring and mapping techniques impact oncological and functional outcomes in supratentorial function-eloquent brain tumours: a systematic review and meta-analysis.
EClinicalMedicine
February 2025
Department of Neurosurgery, King's College Hospital Foundation Trust, London, UK.
Background: Supratentorial function-eloquent brain tumour surgeries challenge the balance between maximal tumour resection and preservation of neurological function. This study aims to evaluate the efficacy of preoperative and intraoperative mapping techniques on resection outcomes and post-operative deficits.
Methods: This systematic review and meta-analysis examined literature up to March 2023, sourced from PubMed, Embase, and Medline.
Case report: Potential physiological sources of the late response in epidural spinal recordings induced by spinal cord stimulation during intraoperative neuromonitoring.
Clin Neurophysiol Pract
December 2024
NeuRAL Lab, Abbott Neuromodulation, Plano, TX 75024, USA.
Objective: This study aims to investigate the sources of later response in epidural spinal recordings (ESRs) obtained from implanted leads during spinal cord stimulation, a topic has not been widely studied in previous research.
Methods: Two patients with lower back and lower extremity pain underwent SCS implantation with intraoperative neuromonitoring (IONM). The timing of extracted peaks in ESRs and intramuscular electromyography (EMG) recordings were analyzed and compared to a Monte Carlo simulation for synchronization analysis.
Intraoperative Monitoring of Sensory Evoked Potentials in Neurosurgery: A Personalized Approach.
J Pers Med
January 2025
E.N. Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia.
Sensory evoked potentials (EPs), namely, somatosensory, visual, and brainstem acoustic EPs, are used in neurosurgery to monitor the corresponding functions with the aim of preventing iatrogenic neurological complications. Functional deficiency usually precedes structural defect, being initially reversible, and prompt alarms may help surgeons achieve this aim. However, sensory EP registration requires presenting multiple stimuli and averaging of responses, which significantly lengthen this procedure.
View Article and Find Full Text PDFA systematic review and meta-analysis of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve during minimally invasive esophagectomy.
J Thorac Dis
December 2024
Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
Background: Minimally invasive esophagectomy (MIE) can lead to a severe complication known as recurrent laryngeal nerve paralysis (RLNP). Existing literature supports that recurrent laryngeal nerve (RLN) injury is the principal etiology of RLNP, a complication potentially mitigated through intraoperative neuromonitoring (IONM). In this study, we examined the comprehensive effectiveness of IONM during esophageal resection by performing a meta-analysis.
View Article and Find Full Text PDFS8 Navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression to reduce postoperative neurological deterioration in thoracic ossification of the ligamentum flavum.
Eur Spine J
January 2025
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
Background: Posterior laminectomy is a standard treatment for thoracic ossification of the ligamentum flavum (TOLF), but it often leads to neurological deterioration during surgery. This study aimed to reduce iatrogenic neurological deterioration by using an S8 navigation system combined with an ultrasonic osteotome for three-dimensional real-time dynamic visualization decompression.
Methods: A retrospective analysis was conducted on patients who underwent laminectomy and internal fixation for TOLF in our centre from January 2016 to January 2023.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!