Standards for Intraoperative Neuromonitoring in Thyroid Operations

김훈엽; Xiaoli Liu; 채영준; Ralph Tufano; Henning Dralle; Gianlorenzo Dionigi

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자료유형: 학술저널

저자정보: 김훈엽 Xiaoli Liu 채영준 Ralph Tufano Henning Dralle Gianlorenzo Dionigi

저널정보: 대한갑상선-내분비외과학회 The Journal of Endocrine Surgery The Journal of Endocrine Surgery 제18권 제1호

발행연도: 2018.1

수록면: 37 - 48 (12page)

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After the introduction of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) in clinical thyroid practice almost 16 years ago, the procedure has expanded rapidly with an area-wide spread in Asia, Europe, and USA. While the visual nerve presentation with the eye or the magnifying glass technique is capable of assessing the anatomical continuity of the RLN, IONM additionally allows a functional analysis that has a high correlation, i.e., prediction of postoperative vocal motility. Although the predictive value of the IONM is much higher (>97%) in the case of an intact signal than in the case of a signal failure (40%–70%), the prediction is also unequally higher than the visual-anatomical assessment of the nerve. Thus, IONM can be used as a basis for an intraoperative decision-making of a 1-side or 2-side procedure to avoid bilateral RLN palsy in a bilateral procedure. A precondition for the safe application of IONM is the perfect knowledge of the technology and technique, the routine execution of preoperative and postoperative laryngoscopy, the strict standardization of the neurostimulation (electromyography documentation of the vagal nerve stimulation before and after resection), and an adequate management of technically or operationally caused incidents (i.e., systematic application of troubleshooting algorithms). The following review provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the correct use of IONM.

참고문헌 (31)

참고문헌 신청

Dralle H / 2004 / Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery / Surgery 136:1310~1322

Hermann M / 2002 / Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk / Ann Surg 235:261~268

Cho I / 2017 / Some posterior branches of extralaryngeal recurrent laryngeal nerves have motor fibers / Laryngoscope

Baek SK / 2017 / Efficiency of intraoperative neuromonitoring on voice outcomes after thyroid surgery / Auris Nasus Larynx 44:583~589

Cha W / 2016 / Supramaximal neurostimulation with laryngeal palpation to predict postoperative vocal fold mobility / Laryngoscope 126:2863~2868

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이 논문의 저자 정보

Kim Hoon Yub

소속기관 Department of Surgery KUMC Thyroid Center Korea University Anam Hospital Korea University College o