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Historical Perspective on Nerve Monitoring During Head and Neck Surgery

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Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery

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Abstract

The history of intraoperative neuromonitoring in head and neck surgery is highlighted by some of the most recognizable figures in medical science. Rising from the birth of electrophysiology, intraoperative neuromonitoring evolved to aid the surgeon’s quest for safe identification and preservation of the nervous system. Specific to head and neck surgery, protection of the cranial nerves remains the Holy Grail, the crux of surgical technique, and the driving force behind the evolution of neurophysiologic monitoring in the head and neck. This chapter reviews the beginnings of electrophysiology, landmark discoveries in neurophysiology, and the last 50 years of technological advancements culminating in the salient intraoperative neuromonitoring used today. We begin with the scholars of antiquity and the discovery of the cranial nerves leading up to the current anatomical classification. Over 250 years ago, Luigi Galvani discovered “animal electricity” marking the beginning of a saga of scientific discovery foundational to nerve monitoring. The last two centuries are highlighted with groundbreaking advancements in electrophysiology, including the discoveries of EEG, EMG, nerve stimulation, and others, many of which were awarded the Nobel Prize. Poised with technological advancements, notable physicians in the late nineteenth century experimented with the medical uses of peripheral nerve stimulation. Nerve monitoring in head and neck surgery became a reality in the 1960s with successful monitoring of the facial and recurrent laryngeal nerves. Since then, nerve monitoring continues to rapidly evolve to provide the surgeon and patient a path toward consistent identification, reliable protection, and ultimate preservation of the cranial nerves.

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References

  1. Porras-Gallo MI, Peña-Meliáan Á, Viejo F, Hernáandez T, Puelles E, Echevarria D, Ramón Sañudo J. Overview of the history of the cranial nerves: from Galen to the 21st century. Anat Rec. 2019;302(3):381–93.

    Article  Google Scholar 

  2. Keele KD. Three early masters of experimental medicine-Erasistratus, Galen and Leonardo da Vinci. Proc R Soc Med. 1961;54:577–88.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Randolph GW. Surgery of the thyroid and parathyroid glands: expert consult premium edition-enhanced online features and print. Elsevier Health Sciences; 2012.

    Google Scholar 

  4. Smith ES. Galen’s account of the cranial nerves and the autonomic nervous system. Clio medica (Amsterdam, Netherlands). 1971;6(2):77.

    CAS  Google Scholar 

  5. Siraisi NG. Vesalius and human diversity in De humani corporis fabrica. J Warburg Courtauld Inst. 1994;57:60–88.

    Article  Google Scholar 

  6. Eustachi B. Opuscula anatomica. 1726.

    Google Scholar 

  7. Corrales CE, Mudry A, Jackler RK. Perpetuation of errors in illustrations of cranial nerve anatomy. J Neurosurg. 2016;127(1):192–8.

    Article  Google Scholar 

  8. Bresadola M. Medicine and science in the life of Luigi Galvani (1737–1798). Brain Res Bull. 1998;46(5):367–80.

    Article  CAS  PubMed  Google Scholar 

  9. Willis T, Wren C. Cerebri anatome: cui accessit nervorum descriptio et usus. Typis Tho. Roycroft, Impensis Jo. Martyn & Ja. Allestry; 1978.

    Google Scholar 

  10. O’Connor JP. Thomas Willis and the background to Cerebri Anatome. J R Soc Med. 2003;96(3):139–43.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Frixione E. Irritable glue: the Haller–Whytt controversy on the mechanism of muscle contraction. In: Brain, mind and medicine: essays in eighteenth-century neuroscience. Boston: Springer; 2007. p. 115–24.

    Chapter  Google Scholar 

  12. Bernardi W. The controversy on animal electricity in eighteenth-century Italy: Galvani, Volta and others. Bevilacqua and Fregonese Eds. Nuova Voltiana. 2000;1:101–4.

    Google Scholar 

  13. Laghi T. De sensitivitate atque irritabilitate Halleriana. In: Fabri GB, editor. Sulla insensitività ed irritabilità Halleriana. Opuscoli di vari autori, vol. 2. Corciolani ed. Bologna: Eredi Colli; 1757. p. 326–45.

    Google Scholar 

  14. Smith CU. Brain and mind in the ‘long’ eighteenth century. In: Brain, mind and medicine: essays in eighteenth-century neuroscience. Boston: Springer; 2007. p. 15–28.

    Chapter  Google Scholar 

  15. Galvani L. De viribus electricitatis in motu musculari. Commentarius. De Bonoiensi Scientiarum et Artium Intituo atque Academie Commentarii. 1791;7:363–418.

    Google Scholar 

  16. Hoff HE. Galvani and the pre-Galvanian electrophysiologists. Ann Sci. 1936;1(2):157–72.

    Article  Google Scholar 

  17. Piccolino M. Luigi Galvani and animal electricity: two centuries after the foundation of electrophysiology. Trends Neurosci. 1997;20(10):443–8.

    Article  CAS  PubMed  Google Scholar 

  18. Kipnis N. Luigi Galvani and the debate on animal electricity, 1791–1800. Ann Sci. 1987;44(2):107–42.

    Article  Google Scholar 

  19. Schuetze SM. The discovery of the action potential. Trends Neurosci. 1983;6:164–8.

    Article  Google Scholar 

  20. Oersted HC. Experiments on the effect of a current of electricity on the magnetic needle. Ann Philos. 1820;16(4):273–6.

    Google Scholar 

  21. Keithley JF. The story of electrical and magnetic measurements: from 500 BC to the 1940s. Hoboken: Wiley; 1999.

    Book  Google Scholar 

  22. Nobili L. “Sur un nouveau galvanomètre”. Bibliothèque Universelle. Sci Arts. 1825;29:119–25.

    Google Scholar 

  23. Hoff HE, Geddes LA. The rheotome and its prehistory: a study in the historical interrelation of electrophysiology and electromechanics. Bull Hist Med. 1957;31(3):212–34.

    CAS  PubMed  Google Scholar 

  24. Berger H. Über das elektrenkephalogramm des menschen. DMW-Deutsche Medizinische Wochenschrift. 1934;60(51):1947–9.

    Article  Google Scholar 

  25. İnce R, Adanır SS, Sevmez F. The inventor of electroencephalography (EEG): Hans Berger (1873–1941). Childs Nerv Syst. 2020;5:1–2.

    Google Scholar 

  26. Kazamel M, Warren PP. History of electromyography and nerve conduction studies: a tribute to the founding fathers. J Clin Neurosci. 2017;43:54–60.

    Article  PubMed  Google Scholar 

  27. Duchenne GB. De l'’électrisation localisée et de son application à la physiologie, à la pathologie et à la thérapeutique. Baillière; 1855.

    Google Scholar 

  28. Duchenne GB. Mécanisme de la physionomie humaine: où, Analyse électro-physiologique de l’expression des passions. J.-B. Baillière; 1876.

    Google Scholar 

  29. Erb WH. Handbuch der Elektrotherapie. FCW Vogel; 1886.

    Google Scholar 

  30. Althaus J. A treatise on medical electricity, theoretical and practical: and its uses in the treatment of paralysis, neuralgia and other diseases. Longmans, Green; 1873.

    Google Scholar 

  31. Adrian ED, Bronk DW. The discharge of impulses in motor nerve fibres: part I. Impulses in single fibres of the phrenic nerve. J Physiol. 1928;66(1):81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gasser HS, Erlanger J. A study of the action currents of nerve with the cathode ray oscillograph. Am J Physiol Legacy Content. 1922;62(3):496–524.

    Article  Google Scholar 

  33. Eaton LM, Lambert EH. Electromyography and electric stimulation of nerves in diseases of motor unit: observations on myasthenic syndrome associated with malignant tumors. J Am Med Assoc. 1957;163(13):1117–24.

    Article  CAS  PubMed  Google Scholar 

  34. Dawson GD. A summation technique for the detection of small evoked potentials. Electroencephalogr Clin Neurophysiol. 1954;6:65–84.

    Article  CAS  PubMed  Google Scholar 

  35. Weddell G, Feinstein B, Pattle RE. The electrical activity of voluntary muscle in man under normal and pathological conditions. Brain J Neurol. 1944;67:178–257.

    Article  Google Scholar 

  36. Faaborg-Andersen K, Buchthal F. Action potentials from internal laryngeal muscles during phonation. Nature. 1956;177(4503):340–1.

    Article  CAS  PubMed  Google Scholar 

  37. Cawthorne T, Wilson T. Indications for intratemporal facial nerve surgery. Arch Otolaryngol. 1963;78(4):43–8.

    Article  Google Scholar 

  38. Jasper H. Electrocorticograms in man. Electroencephalogr Clin Neurophysiol. 1949;2(Suppl):16–29.

    Google Scholar 

  39. Penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex of man as studied by electrical stimulation. Brain. 1937;60(4):389–443.

    Article  Google Scholar 

  40. Krause F. Surgery of the brain and spinal cord: based on personal experiences. New York: Rebman; 1912.

    Google Scholar 

  41. Parsons EC. Electrical stimulation of the facial nerve. Laryngoscope. 1966;76(3):391–406.

    Article  Google Scholar 

  42. Jako GJ. Facial nerve monitor. Trans Am Acad Ophthalmol Otolaryngol. 1965;69:340–2.

    Google Scholar 

  43. Sugita K, Kobayashi S. Technical and instrumental improvements in the surgical treatment of acoustic neurinomas. J Neurosurg. 1982;57(6):747–52.

    Google Scholar 

  44. Prass RL, Lüders H. Acoustic (loudspeaker) facial electromyographic monitoring: part 1. Evoked electromyographic activity during acoustic neuroma resection. Neurosurgery. 1986;19(3):392.

    Google Scholar 

  45. Delgado TE, Buchheit WA, Rosenholtz HR, Chrissian S. Intraoperative monitoring of facial muscle evoked responses obtained by intracranial stimulation of the facial nerve: a more accurate technique for facial nerve dissection. Neurosurgery. 1979;4(5):418–21.

    Article  CAS  PubMed  Google Scholar 

  46. Møller AR, Jannetta PJ. Preservation of facial function during removal of acoustic neuromas: use of monopolar constant-voltage stimulation and EMG. J Neurosurg. 1984;61(4):757–60.

    Article  PubMed  Google Scholar 

  47. Møller MB, Møller AR. Loss of auditory function in microvascular decompression for hemifacial spasm: results in 143 consecutive cases. J Neurosurg. 1985;63(1):17–20.

    Article  PubMed  Google Scholar 

  48. Harner SG, Daube JR, Ebersold, MJ, Beatty CW Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas. In: Mayo Clinic proceedings, vol. 62, no. 2. Elsevier; 1987 Feb 1. p. 92–102.

    Google Scholar 

  49. Harner SG, Daube JR, Beatty CW, Ebersold MJ. Intraoperative monitoring of the facial nerve. Laryngoscope. 1988;98(2):209–12.

    Article  CAS  PubMed  Google Scholar 

  50. Silverstein H, Smouha E, Jones R. Routine identification of the facial nerve using electrical stimulation during otological and neurotological surgery. Laryngoscope. 1988;98(7):726–30.

    Article  CAS  PubMed  Google Scholar 

  51. Neuroma A. Consensus statement/NIH consensus development conference. Natl Inst Health Consens Dev Conf. 1991;9:1–24.

    Google Scholar 

  52. Sood AJ, Houlton JJ, Nguyen SA, Gillespie MB. Facial nerve monitoring during parotidectomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2015;152(4):631–7.

    Article  PubMed  Google Scholar 

  53. Sampath P, Holliday MJ, Brem H, Niparko JK, Long DM. Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention. J Neurosurg. 1997;87(1):60–6.

    Article  CAS  PubMed  Google Scholar 

  54. Dickins JR, Graham SS. A comparison of facial nerve monitoring systems in cerebellopontine angle surgery. Am J Otol. 1991;12(1):1–6.

    CAS  PubMed  Google Scholar 

  55. Leonetti JP, Brackmann DE, Prass RL. Improved preservation of facial nerve function in the infratemporal approach to the skull base. Otolaryngol Head Neck Surg. 1989;101(1):74–8.

    Article  CAS  PubMed  Google Scholar 

  56. Hsieh HS, Wu CM, Zhuo MY, Yang CH, Hwang CF. Intraoperative facial nerve monitoring during cochlear implant surgery: an observational study. Medicine. 2015;94(4):e456.

    Google Scholar 

  57. Heman-Ackah SE, Gupta S, Lalwani AK. Is facial nerve integrity monitoring of value in chronic ear surgery? Laryngoscope. 2013;123(1):2–3.

    Article  PubMed  Google Scholar 

  58. Selesnick SH, Lynn-Macrae AG. The incidence of facial nerve dehiscence at surgery for cholesteatoma. Otol Neurotol. 2001;22(2):129–32.

    Article  CAS  PubMed  Google Scholar 

  59. Gidley PW, Maw J, Gantz B, Kaylie D, Lambert P, Malekzadeh S, Chandrasekhar SS. Contemporary opinions on intraoperative facial nerve monitoring. OTO Open. 2018;2(3):2473974X18791803.

    Google Scholar 

  60. Lahey RF. Routine dissection and demonstration of the recurrent laryngeal nerve in subtotal thyroidectomy. Surg Gynecol Obstet. 1938;66:775–7.

    Google Scholar 

  61. Riddell V. Thyroidectomy: prevention of bilateral recurrent nerve palsy, results of identification of the nerve over 23 consecutive years (1946-69) with a description of an additional safety measure. Br J Surg. 1970;57(1):1–1.

    Article  CAS  PubMed  Google Scholar 

  62. Kratz RC. The identification and protection of the laryngeal motor nerves during thyroid and laryngeal surgery: a new microsurgical technique. Laryngoscope. 1973;83(1):59–77.

    Article  CAS  PubMed  Google Scholar 

  63. Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg. 1966;163(1):47.

    Google Scholar 

  64. Zini C, Gandolfi A. Facial-nerve and vocal-cord monitoring during otoneurosurgical operations. Arch Otolaryngol Head Neck Surg. 1987;113(12):1291–3.

    Article  CAS  PubMed  Google Scholar 

  65. Engel PM, Büter HA, Page PS, Mos A. A device for the location and protection of the recurrent laryngeal nerve during operations upon the neck. Surg Gynecol Obstet. 1981;152(6):825–6.

    CAS  PubMed  Google Scholar 

  66. Gavilán J, Gavilán C. Recurrent laryngeal nerve: identification during thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg. 1986;112(12):1286–8.

    Article  PubMed  Google Scholar 

  67. James AG, Crocker S, Woltering E, Ferrara J, Farrar W. A simple method for identifying and testing the recurrent laryngeal nerve. Surg Gynecol Obstet. 1985;161:185–6.

    Google Scholar 

  68. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World J Surg. 2004;28(8):755–60.

    Article  PubMed  Google Scholar 

  69. Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol. 1970;69(sup263):63–7.

    Google Scholar 

  70. Rea JL, Davis WE, Templer JW. Recurrent nerve locating system. Ann Otol Rhinol Laryngol. 1979;88(1):92–4.

    Article  CAS  PubMed  Google Scholar 

  71. Lipton RJ, McCaffrey TV, Litchy WJ. Intraoperative electrophysiologic monitoring of laryngeal muscle during thyroid surgery. Laryngoscope. 1988;98(12):1292–6.

    Article  CAS  PubMed  Google Scholar 

  72. Rice DH, Cone-Wesson B. Intraoperative recurrent laryngeal nerve monitoring. Otolaryngol Head Neck Surg. 1991;105(3):372–5.

    Article  CAS  PubMed  Google Scholar 

  73. Maloney RW, Murcek BW, Steehler KW, Sibly D, Maloney RE. A new method for intraoperative recurrent laryngeal nerve monitoring. Ear Nose Throat J. 1994;73(1):30–3.

    Article  CAS  PubMed  Google Scholar 

  74. Goldstone AC. The electrode endotracheal tube: a state of the art method for monitoring recurrent laryngeal nerve-vocal cord muscle integrity in the intubated patient. Otolaryngol Head Neck Surg. 1990;103:249.

    Google Scholar 

  75. Rea JL. Postcricoid surface laryngeal electrode. Ear Nose Throat J. 1992;71(6):267–9.

    Article  CAS  PubMed  Google Scholar 

  76. Marcus B, Edwards B, Yoo S, Byrne A, Gupta A, Kandrevas J, Bradford C, Chepeha DB, Teknos TN. Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery: the University of Michigan experience. Laryngoscope. 2003;113(2):356–61.

    Article  PubMed  Google Scholar 

  77. Beck DL, Maves MD. Recurrent laryngeal nerve monitoring during thyroid surgery. Neuromonitoring in otology and head and neck surgery. Raven, New York. 1992:151–62. In the surgical treatment of acoustic neurinomas. J Neurosurg. 1982;57:747–52.

    Google Scholar 

  78. Barczyński M, Konturek A, Cichoń S. Value of the intraoperative neuromonitoring in surgery for thyroid cancer in identification and prognosis of function of the recurrent laryngeal nerves. Endokrynol Pol. 2006;57(4):343–56.

    PubMed  Google Scholar 

  79. Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery. 2004;136(6):1107–15.

    Article  PubMed  Google Scholar 

  80. Higgins TS, Gupta R, Ketcham AS, Sataloff RT, Wadsworth JT, Sinacori JT. Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope. 2011;121(5):1009–17.

    Article  PubMed  Google Scholar 

  81. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voß J, Thomusch O. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136(6):1310–22.

    Article  PubMed  Google Scholar 

  82. Serpell J, Sidhu S, Vallance N, Panizza B, Randolph G. Consensus statement on intra-operative electrophysiological recurrent laryngeal nerve monitoring during thyroid surgery. ANZ J Surg. 2014;84(9):603–4.

    Article  PubMed  Google Scholar 

  83. Randolph GW, Dralle H, with the International Intraoperative Monitoring Study Group, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121(S1):S1–6.

    Article  PubMed  Google Scholar 

  84. Schneider R, Randolph GW, Barczynski M, Dionigi G, Wu CW, Chiang FY, Machens A, Kamani D, Dralle H. Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology. Gland Surg. 2016;5(6):607.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Lamadé W, Ulmer C, Seimer A, Molnar V, Meyding-Lamadé U, Thon KP, Koch KP. A new system for continuous recurrent laryngeal nerve monitoring. Minim Invasive Ther Allied Technol. 2007;16(3):149–54.

    Article  PubMed  Google Scholar 

  86. Sinclair CF, Téllez MJ, Ulkatan S. Noninvasive, tube-based, continuous vagal nerve monitoring using the laryngeal adductor reflex: feasibility study of 134 nerves at risk. Head Neck. 2018;40(11):2498–506.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. University of Virginia, Department of Otolaryngology, Head and Neck Surgery, Charlottesville, VA, USA

    Jeffrey Mella & David C. Shonka Jr.

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  1. Jeffrey Mella
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  2. David C. Shonka Jr.
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Correspondence to David C. Shonka Jr. .

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Editors and Affiliations

  1. Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA

    Joseph Scharpf

  2. Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Gregory W. Randolph

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Mella, J., Shonka, D.C. (2022). Historical Perspective on Nerve Monitoring During Head and Neck Surgery. In: Scharpf, J., Randolph, G.W. (eds) Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84916-0_1

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