Skip to main content
SpringerLink
Log in

Operationstechnik: Neuromonitoring bei Schilddrüsenoperationen (cIONM, iIONM)

  • Chapter
  • First Online:
Endokrine Chirurgie

Part of the book series: Springer Reference Medizin ((SRM))

  • 1116 Accesses

Zusammenfassung

Mit dem intraoperativen Monitoring des N. vagus und N. laryngeus recurrens und dessen Weiterentwicklung in den letzten 20 Jahren steht eine Technik zur Verfügung, mit deren Hilfe die Stimmlippenfunktion im Rahmen von zervikalen operativen Eingriffen anatomisch-funktionell zweifelsfrei dargestellt werden kann. Der wesentliche Vorteil gegenüber der alleinigen visuellen Nervendarstellung besteht darin, dass auch nichtanatomische, funktionell jedoch gleichwohl relevante Nervenstörungen bereits intraoperativ erkannt und postoperative Stimmlippenparesen vorhergesagt werden können. Seit kurzem ist zusätzlich zur Technik der intermittierenden Stimulation eine neue Technik zur kontinuierlichen Stimulation entwickelt worden, die durch Echtzeitanalyse bereits den drohenden Nervenschaden anhand kombinierter EMG-Ereignisse erkennen und verhindern, oder aber die intraoperative Erholung des EMG-Signals identifizieren kann. Eine jüngste multivariate Analyse konnte die Überlegenheit des kontinuierlichen gegenüber dem intermittierenden Neuromonitoring zeigen. Dieses Buchkapitel gibt einen Überblick über das dynamische Voranschreiten der intraoperativen Nervenkontrolle durch die Implementierung des kontinuierlichen Neuromonitorings in der Schilddrüsenchirurgie unter EMG-adaptierter intraoperativer Entscheidungsfindung und Resektionsstrategie sowie Präparationsform für die größtmögliche Patientensicherheit.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  • Anuwong A, Lavazza M, Kim HY et al (2016) Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring. Updates Surg 68:331–341

    Article  PubMed  Google Scholar 

  • Barczyński M, Konturek A, Cichoń S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96:240–246

    Article  PubMed  Google Scholar 

  • Barczyński M, Randolph GW, Cernea C et al (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 123:1–14

    Article  Google Scholar 

  • Barczyński M, Randolph GW, Cernea C et al (2016) International survey on the identification and neural monitoring of the EBSLN during thyroidectomy. Laryngoscope 126:285–291

    Article  PubMed  Google Scholar 

  • Bartsch DK, Dotzenrath C, Vorländer C et al (2019) The StuDoQ/Thyroid Study Group TSS. Current practice of surgery for benign goitre – an analysis of the prospective DGAV StuDoQ|Thyroid Registry. J Clin Med 8:477

    Article  PubMed Central  Google Scholar 

  • Bergenfelz A, Salem AF, Jacobsson H et al (2016) Risk of recurrent laryngeal nerve palsy in patients undergoing thyroidectomy with and without intraoperative nerve monitoring. Br J Surg 103:1828–1838

    Article  CAS  PubMed  Google Scholar 

  • Brauckhoff K, Vik R, Sandvik L et al (2016) Impact of EMG changes in continuous vagal nerve monitoring in high-risk endocrine neck surgery. World J Surg 40:672–780

    Article  PubMed  Google Scholar 

  • Brauckhoff M, Machens A, Sekulla C et al (2011) Latencies shorter than 3.5 ms after vagus nerve stimulation signify a nonrecurrent inferior laryngeal nerve before dissection. Ann Surg 253:1172–1177

    Article  PubMed  Google Scholar 

  • Calò PG, Pisano G, Medas F et al (2014) Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg 43:16–23

    Article  PubMed  PubMed Central  Google Scholar 

  • Cavicchi O, Burgio L, Cioccoloni E et al (2018) Intraoperative intermittent neuromonitoring of inferior laryngeal nerve and staged thyroidectomy: our experience. Endocrine 62:560–565

    Article  CAS  PubMed  Google Scholar 

  • De la Quintana BA, Iglesias Martínez A, Salutregui I et al (2018) Continuous monitoring of the recurrent laryngeal nerve. Langenbecks Arch Surg 403:333–339

    Article  Google Scholar 

  • Dionigi G, Boni L, Rovera F et al (2010) Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg 395:327–331

    Article  PubMed  Google Scholar 

  • Dionigi G, Chiang FY, Dralle H et al (2013) Safety of neural monitoring in thyroid surgery. Int J Surg 11:S120–S126

    Article  PubMed  Google Scholar 

  • Dralle H, Sekulla C, Lorenz K et al (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32:1358–1366

    Article  CAS  PubMed  Google Scholar 

  • Dralle H, Sekulla C, Lorenz K et al (2012) Loss of the nerve monitoring signal during bilateral thyroid surgery. Br J Surg 99:1089–1095

    Article  CAS  PubMed  Google Scholar 

  • Dralle H, Lorenz K, Schabram P et al (2013) Intraoperative neuromonitoring in thyroid surgery. Recommendations of the Surgical Working Group for Endocrinology. Chirurg 84:1049–1056

    Article  CAS  PubMed  Google Scholar 

  • Feng AL, Puram SV, Singer MC et al (2020) Increased prevalence of neural monitoring during thyroidectomy: global surgical survey. Laryngoscope 130:1097–1104

    Article  PubMed  Google Scholar 

  • Flisberg K, Lindholm T (1969) Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl 263:63–67

    CAS  PubMed  Google Scholar 

  • Friedrich C, Ulmer C, Rieber F et al (2012) Safety analysis of vagal nerve stimulation for continuous nerve monitoring during thyroid surgery. Laryngoscope 122:1979–1987

    Article  PubMed  Google Scholar 

  • Goretzki PE, Schwarz K, Brinkmann J et al (2010) The impact of intraoperative neuromonitoring (IONM) on surgical strategy in bilateral thyroid diseases: is it worth the effort? World J Surg 34:1274–1284

    Article  PubMed  Google Scholar 

  • Hamilton N, Morley H, Haywood M et al (2019) Continuous intraoperative nerve monitoring in thyroidectomy using automatic periodic stimulation in 256 at-risk nerves. Ann R Coll Surg Engl 101:432–435

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Higgins TS, Gupta R, Ketcham AS et al (2011) Recurrent laryngeal nerve monitoring versus identification alone on post-thyroidectomy true vocal fold palsy: a meta-analysis. Laryngoscope 121:1009–1017

    Article  PubMed  Google Scholar 

  • Jonas J, Boskovic A (2014) Intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve protection: comparison of intermittent and continuous nerve stimulation. Surg Technol Int 24:133–138

    PubMed  Google Scholar 

  • Lorenz K, Abuazab M, Sekulla C et al (2014) Results of intraoperative neuromonitoring in thyroid surgery and preoperative vocal cord paralysis. World J Surg 38:582–591

    Article  PubMed  Google Scholar 

  • Marin Arteaga A, Peloni G, Leuchter I et al (2018) Modification of the surgical strategy for the dissection of the recurrent laryngeal nerve using continuous intraoperative nerve monitoring. World J Surg 42:444–450

    Article  PubMed  Google Scholar 

  • Marti JL, Holm T, Randolph G (2016) Universal use of intraoperative nerve monitoring by recently fellowship-trained thyroid surgeons is common, associated with higher surgical volume, and impacts intraoperative decision-making. World J Surg 40:337–343

    Article  PubMed  Google Scholar 

  • Melin M, Schwarz K, Pearson MD et al (2014) Postoperative vocal cord dysfunction despite normal intraoperative neuromonitoring: an unexpected complication with the risk of bilateral palsy. World J Surg 38:2597–2602

    Article  PubMed  Google Scholar 

  • Musholt TJ, Bockisch A, Clerici T et al (2018) Update of the S2k guidelines: surgical treatment of benign thyroid diseases. Chirurg 89:699–709

    Article  CAS  PubMed  Google Scholar 

  • Phelan E, Schneider R, Lorenz K et al (2014) Continuous vagal IONM prevents RLN paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. Laryngoscope 124:1498–1505

    Article  PubMed  Google Scholar 

  • Randolph GW, Dralle H, Abdullah H et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121:1–16

    Article  Google Scholar 

  • Ritter A, Ganly I, Wong RJ et al (2020) Intraoperative nerve monitoring is used routinely by a significant majority of head and neck surgeons in thyroid surgery and impacts on extent of surgery – survey of the American Head and Neck Society. Head Neck (e-pub ahead of print). https://doi.org/10.1002/hed.26093

  • Sadowski SM, Soardo P, Leuchter I et al (2013) Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid 23:329–333

    Article  PubMed  Google Scholar 

  • Schneider R, Przybyl J, Pliquett U et al (2010) A new vagal anchor electrode for real-time monitoring of the recurrent laryngeal nerve. Am J Surg 199:507–514

    Article  PubMed  Google Scholar 

  • Schneider R, Randolph G, Sekulla C et al (2013) Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 35:1591–1598

    Article  PubMed  Google Scholar 

  • Schneider R, Lorenz K, Sekulla C et al (2015a) Surgical strategy during intended total thyroidectomy after loss of EMG signal on the first side of resection. Chirurg 86:154–163

    Article  CAS  PubMed  Google Scholar 

  • Schneider R, Sekulla C, Machens A et al (2015b) Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. Br J Surg 102:1380–1387

    Article  CAS  PubMed  Google Scholar 

  • Schneider R, Machens A, Bucher M et al (2016a) Continuous intraoperative monitoring of vagus and recurrent laryngeal nerve function in patients with advanced atrioventricular block. Langenbeck’s Arch Surg 401:551–556

    Article  Google Scholar 

  • Schneider R, Randolph G, Dionigi G et al (2016b) Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: the International Neural Monitoring Study Group’s POLT Study. Laryngoscope 126:1260–1266

    Article  PubMed  Google Scholar 

  • Schneider R, Sekulla C, Machens A et al (2016c) Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function. Head Neck 38:E1144–E1151

    Article  PubMed  Google Scholar 

  • Schneider R, Machens A, Randolph G et al (2017) Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery. Gland Surg 6:537–545

    Article  PubMed  PubMed Central  Google Scholar 

  • Schneider R, Machens A, Sekulla C et al (2018a) Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring. Br J Surg 105:996–1005

    Article  CAS  PubMed  Google Scholar 

  • Schneider R, Randolph G, Dionigi G et al (2018b) International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 128:S1–S17

    Article  PubMed  Google Scholar 

  • Schneider R, Machens A, Randolph G et al (2019a) Impact of continuous intraoperative vagus stimulation on intraoperative decision making in favor of or against bilateral surgery in benign goiter. Best Pract Res Clin Endocrinol Metab 33:101285

    Article  PubMed  Google Scholar 

  • Schneider R, Randolph G, Dionigi G et al (2019b) Prediction of postoperative vocal fold function after intraoperative recovery of loss of signal. The International Neuromonitoring Study Group’s PREC Study. Laryngoscope 129:525–531

    Article  PubMed  Google Scholar 

  • Schneider R, Machens A, Lorenz K, Dralle H (2020) Intraoperative nerve monitoring in thyroid surgery-shifting current paradigms. Gland Surg 9:S120–S128

    Article  PubMed  PubMed Central  Google Scholar 

  • Schneider R, Machens A, Sekulla C et al (2021) Superiority of continuous over intermittent intraoperative nerve monitoring in preventing vocal cord palsy. Br J Surg 108:566–573 [accepted for publication]

    Google Scholar 

  • Sedlmeier A, Steinmüller T, Hermanns M et al (2019) Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: a retrospective analysis and prospective follow-up. Clin Otolaryngol 44:1071–1079

    Article  Google Scholar 

  • Terris DJ, Chaung K, Duke WS (2015) Continuous vagal nerve monitoring is dangerous and should not routinely be done during thyroid surgery. World J Surg 39:2471–2476

    Article  PubMed  Google Scholar 

  • Thomusch O, Machens A, Sekulla C et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341

    Article  CAS  PubMed  Google Scholar 

  • Thomusch O, Sekulla C, Machens A et al (2004) Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg 389:499–503

    Article  PubMed  Google Scholar 

  • Timmermann W, Hamelmann WH, Thomusch O et al (2004) Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery. Chirurg 75:916–922

    Google Scholar 

  • Ulmer C, Koch K, Seimer A et al (2008) Real-time monitoring of the recurrent laryngeal nerve: an observational clinical trial. Surgery 143:359–365

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Viszeral-, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Martin-Luther Universität Halle-Wittenberg, Halle an der Saale, Deutschland

    Rick Schneider & Kerstin Lorenz

  2. Klinik für Viszerale, Gefäß und Endokrine Chirurgie, Universitätsklinikum, Martin-Luther Universität Halle-Wittenberg, Halle (Saale), Deutschland

    Ilker Satiroglu

Authors
  1. Rick Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ilker Satiroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerstin Lorenz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rick Schneider .

Editor information

Editors and Affiliations

  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitästklinikum Gießen und Marburg GmbH, Marburg, Deutschland

    Detlef K. Bartsch

  2. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitästklinikum Gießen und Marburg GmbH, Marburg, Deutschland

    Katharina Holzer

Section Editor information

  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland

    Detlef K. Bartsch

  2. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Marburg, Deutschland

    Katharina Holzer

1 Elektronisches Zusatzmaterial

Medialer Zugang (MP4 552369 kb)

Lateraler Zugang (MP4 519456 kb)

Stimulation rechts nach (MP4 145798 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Der/die Autor(en), exklusiv lizenziert an Springer-Verlag GmbH, DE, ein Teil von Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Schneider, R., Satiroglu, I., Lorenz, K. (2023). Operationstechnik: Neuromonitoring bei Schilddrüsenoperationen (cIONM, iIONM). In: Bartsch, D.K., Holzer, K. (eds) Endokrine Chirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-63317-5_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-63317-5_7

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-63316-8

  • Online ISBN: 978-3-662-63317-5

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation