Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement
Gregory W Randolph, Henning Dralle, International Intraoperative Monitoring Study Group, Hisham Abdullah, Marcin Barczynski, Rocco Bellantone, Michael Brauckhoff, Bruno Carnaille, Sergii Cherenko, Fen-Yu Chiang, Gianlorenzo Dionigi, Camille Finck, Dana Hartl, Dipti Kamani, Kerstin Lorenz, Paolo Miccolli, Radu Mihai, Akira Miyauchi, Lisa Orloff, Nancy Perrier, Manuel Duran Poveda, Anatoly Romanchishen, Jonathan Serpell, Antonio Sitges-Serra, Tod Sloan, Sam Van Slycke, Samuel Snyder, Hiroshi Takami, Erivelto Volpi, Gayle Woodson, Gregory W Randolph, Henning Dralle, International Intraoperative Monitoring Study Group, Hisham Abdullah, Marcin Barczynski, Rocco Bellantone, Michael Brauckhoff, Bruno Carnaille, Sergii Cherenko, Fen-Yu Chiang, Gianlorenzo Dionigi, Camille Finck, Dana Hartl, Dipti Kamani, Kerstin Lorenz, Paolo Miccolli, Radu Mihai, Akira Miyauchi, Lisa Orloff, Nancy Perrier, Manuel Duran Poveda, Anatoly Romanchishen, Jonathan Serpell, Antonio Sitges-Serra, Tod Sloan, Sam Van Slycke, Samuel Snyder, Hiroshi Takami, Erivelto Volpi, Gayle Woodson
Abstract
Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.
Source: PubMed