This comprehensive atlas is the modern, state-of-the-art guide for intraoperative neurophysiologic monitoring (IONM) and management of the recurrent laryngeal nerve, vagus nerve and other cranial nerves at risk during thyroid, parathyroid and modified radical neck dissection surgery. Based on real-time electrophysiologic images, it will assist the surgeon in the decision-making process by incorporating important information related to the identification of the nerves and their functional status, aiding in the interpretation and improvement of the quality of neural monitoring and reducing inappropriate variations in monitoring technique. Utilization of IONM enables the surgeon to interrogate nerve anatomy and function with immediate quantitative feedback, thereby augmenting surgical training, and importantly, surgical skills and sound anatomic knowledge remain prerequisite and are not supplanted by IONM use.
Authored by experts in the field, Atlas of Intraoperative Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery will be the gold-standard text for IONM for endocrine surgeons, otolaryngology surgeons, neurophysiologists, and head and neck surgeons, as well as fellows and residents in these areas.
Author(s): Alexander L. Shifrin, Alan D. Deutsch, Gregory W. Randolph
Publisher: Springer
Year: 2023
Language: English
Pages: 105
City: Cham
Preface
Acknowledgments
Contents
Contributors
1: Anatomy and Function of Cranial and Neck Nerves
Introduction
Summary of Cranial Nerves I–VI, VII, and IX
CNI: The Olfactory Nerve
CNII: The Optic Nerve
CNIII: The Oculomotor Nerve
CN IV: The Trochlear Nerve
CN V: The Trigeminal Nerve
CN VI: The Abducens Nerve
CN IX: The Glossopharyngeal Nerve
CN VII: The Facial Nerve
Anatomy
Function
CN X: The Vagus Nerve
Anatomy
Function
Branches of the Vagus Nerve
The Recurrent Laryngeal Nerve (RLN)
Superior Laryngeal Nerve (SLN)
The Internal Branch of the Superior Laryngeal Nerve (IBSLN)
The External Branch of the Superior Laryngeal Nerve (EBSLN)
Communicating “Anastomoses” Between SLN and RLN
Galen’s Anastomosis
Extra-Laryngeal Anastomosis Between the RLN and the EBSLN
CN XI: The Spinal Accessory Nerve
CN XII: The Hypoglossal Nerve
Phrenic Nerve
References
2: Electrophysiological Equipment
Medtronic
NIM 3.0 System
NIM Vital
NIM TriVantage EMG Tubes
Inomed
C2 Explore
Cadwell
Cascade IOMAX
CadX
Cascade Surgical Studio (CSS)
References
3: Intraoperative Neurophysiologic Monitoring: A Neurologic Perspective
References
4: Intraoperative Neurophysiological Monitoring Anesthesia Perspective
Introduction
Preoperative Assessment
Intraoperative Management
Anesthesia Emergence
References
5: Intraoperative Neurophysiological Monitoring Surgical Perspective
Introduction
Rationale for Intraoperative Nerve Monitoring
Preventing Vocal Fold Injury
Types of Intraoperative Nerve Monitoring
Safety of Intraoperative Nerve Monitoring
Limitations
Conclusions
References
6: Electrophysiologic RLN and Vagal Monitoring During Thyroid and Parathyroid Surgery
Introduction
Brief History of IONM
Prevalence and Patterns of IONM Use
Role in Education
Rationale and Indications for IONM
Rates and Impact of Vocal Cord Paralysis
Role of Preoperative Laryngeal Examination
Evidence Basis for Benefit of IONM
IONM Standards of Use and Applications
Surgical Anatomy of the Vagus/RLN
Normal Anatomy
Variant Anatomy
Standard Set-up and Troubleshooting
Standard Set-up
Signal Interpretation and Troubleshooting
RLN Injury and Loss of Signal
Mechanisms of RLN Injury
Loss of Signal
IONM and RLN Invasion
Neuromonitoring in Parathyroid Surgery
Conclusions
References
7: External Branch of the Superior Laryngeal Nerve (EBSLN) Monitoring During Thyroid and Parathyroid Surgery
Introduction
Surgical Anatomy
How to Avoid Injury to the EBSLN During Thyroidectomy
How to Diagnose the EBSLN Paralysis?
Intraoperative Monitoring of the EBSLN
Relevance of EBSLN Intraoperative Monitoring
Does EBSLN Intraoperative Monitoring Reduce the Frequency of Nerve Injury?
Frequency of Use of EBSLN Intraoperative Nerve Monitoring
Normative Features of EBSLN Intraoperative Monitoring
Prognostic Parameters of the EBSLN and Change in Voice Quality Postoperatively
Take-Home Messages
References
8: Intraoperative Neurophysiologic Monitoring for the Recurrent Laryngeal Nerve: Case Illustrations
Further Reading
9: Intraoperative Neurophysiological Monitoring for the External Branch of the Superior Laryngeal Nerve: Case Illustrations
Further Reading
10: Intraoperative Neurophysiological Monitoring for the Vagus Nerve: Case Illustrations
Further Reading
11: Intraoperative Neurophysiological Monitoring for the Spinal Accessory Nerve: Case Illustrations
Further Reading
12: Intraoperative Neurophysiological Monitoring for the Hypoglossal Nerve: Case Illustrations
Further Reading
13: Intraoperative Neurophysiological Monitoring for the Phrenic Nerve: Case Illustrations
Further Reading
14: Continuous Intraoperative Neuromonitoring in Thyroid Surgery
Introduction
Prerequisites for CIONM
Evaluation of VC Movement
Concept of the Dominant Side
Informed Consent
CIONM Equipment
Anesthesia and Endotracheal Tube Positioning
Procedure
Evaluation of EMG Data
Impending Neuronal Damage
Artifacts
Signal Recovery
Definite Loss of EMG Signal and Staged Thyroidectomy
References
15: Intraoperative Neuromonitoring of the RLNs During TOETVA Procedures
Introduction
The RLN Approach and Dissection in TOETVA
The RLN Injury During TOETVA 2
The EBSLN Approach and Dissection in TOETVA
IONM Key Steps in TOETVA
IONM Procedure with Long Stimulating Probe
IONM Guidance with Percutaneous Stimulating Probe
IONM Operative Strategy with Dissecting and Stimulating Instruments
Advanced Monitoring with C-IONM
IONM Limits in TOETVA
References
Index
