INTRAOPERATIVE
NEUROMONITOGING (IONM) DURING THYROID SURGERY
USEFULNESS
AND EFFECTIVENESS IN PREVENTING RECURRENT LARYNGEAL NERVE PALSY
The role of
IONM in preventing recurrent laryngeal nerve (RLN) palsy remains debated. In a
large prospective multicenter French national study (*), the use of IONM was not
associated with decreased postoperative RLN palsy rate. More importantly, there
was no difference in the rates of definitive recurrent laryngeal nerve palsy. Many
other studies (including one systemic meta-analysis of 20 studies) suggested no
statistically significant benefit of IONM compared to nerve
visualization/protection for the outcomes of overall, transient or permanent
RLN palsy. The use IONM is not recommended in routine practice by the American
Thyroid Association (ATA), but should be considered in selected cases (i.e. patients
with a history of previous neck surgery or thyroid cancer infiltrating adjacent
tissues). Increased cost of routine IONM is also an important consideration. IONM
should not be viewed as a substitute for a good surgical technique.
(*) Surgery
2018 (163): 124 – 129
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