Intermittent (IONM) and continuous (CIONM) intraoperative neuromonitoring can be considered an additional technique to the routine practice of visual identification of the recurrent laryngeal nerve during thyroid surgery. Although visual identification has traditionally been considered the gold standard to prevent nerve injury, no information regarding nerve functional integrity can be obtained from visual identification alone and thus the correlation between anatomical and functional integrity is variable. Intraoperative monitoring (IONM) overcomes these shortfalls of visual identification with benefits related to nerve identification, dissection and functional integrity evaluation.
Many surgical societies and guidelines recommend the use of intraoperative monitoring, especially in surgery for recurrent cancer, locally advanced cancer or large hyperthyroid goiters, all cases of bilateral thyroid surgery and preoperative chordal palsy. However some authors consider the advantages of IONM to be limited especially in the prevention of nerve damage and publications comparing intermittent monitoring to visual identification alone yield mixed results.
In the continuous form of IONM (CIONM), nerve stimulation occurs throughout the endocrine procedure which provides a constant evaluation of nerve and vocal fold functional integrity. The probe can be applied directly to the vagus nerve or the laryngeal reflex can be elicited continuously to perform this function. Continuous IONM methodologies allow potentially harmful surgical maneuvers to be modified in real time and thus has a role in the prevention and prediction of impending nerve damage. In recent years there has been an increased number of publications in peer reviewed literature related to the use of CIONM.
Given the worldwide diffusion of this technique and the worldwide growing interest concerning the medico-legal implications of neural injury, we propose an edition of Frontiers focusing on the experience of different authors with the use of CIONM and the main controversies in the interpretation of the electromyographic plots in each single institute and with different monitoring systems. This edition would also address use of neuromonitoring in novel surgical approaches (eg. robotic / TOETVA) and direct ablative therapies for the treatment of thyroid nodules.
Intermittent (IONM) and continuous (CIONM) intraoperative neuromonitoring can be considered an additional technique to the routine practice of visual identification of the recurrent laryngeal nerve during thyroid surgery. Although visual identification has traditionally been considered the gold standard to prevent nerve injury, no information regarding nerve functional integrity can be obtained from visual identification alone and thus the correlation between anatomical and functional integrity is variable. Intraoperative monitoring (IONM) overcomes these shortfalls of visual identification with benefits related to nerve identification, dissection and functional integrity evaluation.
Many surgical societies and guidelines recommend the use of intraoperative monitoring, especially in surgery for recurrent cancer, locally advanced cancer or large hyperthyroid goiters, all cases of bilateral thyroid surgery and preoperative chordal palsy. However some authors consider the advantages of IONM to be limited especially in the prevention of nerve damage and publications comparing intermittent monitoring to visual identification alone yield mixed results.
In the continuous form of IONM (CIONM), nerve stimulation occurs throughout the endocrine procedure which provides a constant evaluation of nerve and vocal fold functional integrity. The probe can be applied directly to the vagus nerve or the laryngeal reflex can be elicited continuously to perform this function. Continuous IONM methodologies allow potentially harmful surgical maneuvers to be modified in real time and thus has a role in the prevention and prediction of impending nerve damage. In recent years there has been an increased number of publications in peer reviewed literature related to the use of CIONM.
Given the worldwide diffusion of this technique and the worldwide growing interest concerning the medico-legal implications of neural injury, we propose an edition of Frontiers focusing on the experience of different authors with the use of CIONM and the main controversies in the interpretation of the electromyographic plots in each single institute and with different monitoring systems. This edition would also address use of neuromonitoring in novel surgical approaches (eg. robotic / TOETVA) and direct ablative therapies for the treatment of thyroid nodules.
