Intraoperative Neuromonitoring (IONM) for Recurrent Laryngeal Nerve Protection: Comparison of Intermittent and Continuous Nerve Stimulation

Abstract:

Clinical results comparing intermittent intraoperative neuromonitoring (Int-IONM) and continuous IONM (Cont-IONM) for recurrent laryngeal nerve protection are lacking. Int-IONM has been routinely applied in thyroid resection since January 2008. Cont-IONM was added in November 2008 (ISIS; Inomed, Emmendingen, Germany). Rates of vocal cord palsies (VCPs) and the corresponding IONM signals of both methods are compared. Int-IONM was applied in 458 patients and Cont-IONM in 667 patients. Early postoperative VCPs were diagnosed in 4.0% (34/850 NaR) of the Int-IONM group and in 2.9% (34/1184 NaR) of the Cont-IONM group (p = n.s.). The permanent palsy rate was 0.7% (n = 6) for the Int-IONM group, while all VCPs of the Cont-IONM group except one recovered within 1 to 5 months (p = 0.01). First mobilizing the gland is an early risk point for loss of signal (LOS) in 19.1% of cases. VCPs were identified in 58.8% to 85.3% by intraoperative LOS. Recognition of the nerve-threatening surgical action is significantly better for Cont-IONM (67.7% vs. 20.6%; p = 0.0008). In this clinical setup the Cont-IONM method reduces permanent VCP rates significantly in comparison with Int-IONM. The continuous evaluation of signals during the various dissection steps reduces and limits irreversible damage and allows the surgeon to pay increased attention to the functioning of the nerve.

Authors:

Jörg Jonas, MD, PhD, Head of Department, Department of General and Visceral Surgery, St. Marienkrankenhaus, Frankfurt, Germany, Anastasia Boskovic, MD, Assistant of Department, Department of General and Visceral Surgery, St. Marienkrankenhaus, Frankfurt, Germany

PMID:  24526426

Buy and download instantly for only $69!

$69.00
Order Article Copies 

For Direct IP Access please click this link