Langenbeck's Archives of Surgery

, Volume 395, Issue 7, pp 893–899

Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy

  • Gianlorenzo Dionigi
  • Feng-Yu Chiang
  • Stefano Rausei
  • Che-Wei Wu
  • Luigi Boni
  • Ka-Wo Lee
  • Francesca Rovera
  • Giovanni Cantone
  • Alessandro Bacuzzi
Original Article

DOI: 10.1007/s00423-010-0693-3

Cite this article as:
Dionigi, G., Chiang, FY., Rausei, S. et al. Langenbecks Arch Surg (2010) 395: 893. doi:10.1007/s00423-010-0693-3

Abstract

Background

Standardisation of the intraoperative neuromonitoring (IONM) technique is a fundamental aspect in monitored thyroid surgery. Vagal nerve (VN) stimulation is essential for problem solving, recognition of any inferior laryngeal nerve (ILN) lesions and prediction of ILN post-operative function. Issues that have been overlooked in the literature, particularly in terms of prospective approaches, are the topographic relationship of the VN with the carotid and jugular vessels as well as the neurophysiology of the VN and ILN that have been studied, with a prospective approach, in patients with various thyroid diseases.

Methods

Cooperation with the Human Morphology Department resulted in the completion of a dedicated anatomy report, with the clear objective of providing a detailed anatomic and neurophysiologic description of the VN (n = 263).

Results

VN identification and stimulation was feasible in all cases and did not result in increased morbidity or operative time. Most VNs lay on the posterior region of the carotid ship (73%), i.e. the P position in accordance with our model. Mean amplitudes of EMG signals obtained from VN stimulation were 750 ± 279 μV, lower than those obtained with direct INL stimulation (1,086 ± 349 μV).

Conclusion

A better understanding of the variability in the VN may be useful not only to minimise complications but also to guarantee an accurate IONM.

Keywords

Thyroid surgery Neuromonitoring Vagus nerve Recurrent laryngeal nerve Morbidity 

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
  • Feng-Yu Chiang
    • 2
  • Stefano Rausei
    • 1
  • Che-Wei Wu
    • 2
  • Luigi Boni
    • 1
  • Ka-Wo Lee
    • 2
  • Francesca Rovera
    • 1
  • Giovanni Cantone
    • 3
  • Alessandro Bacuzzi
    • 3
  1. 1.Endocrine Surgery Research Centre, Department of Surgical SciencesUniversity of Insubria (Varese–Como)VareseItaly
  2. 2.Department of Otolaryngology - Head and Neck Surgery, Kaohsiung Municipal Hsiao-Kang Hospital, and Kaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  3. 3.Department of AnaesthesiaUniversity of Insubria, Varese–ComoVareseItaly

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