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Validity of intra-operative neuromonitoring signals in thyroid surgery

  • Original Article
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Abstract

Background

Although intra-operative neuromonitoring (IONM) is widely used in thyroid surgery, the validity of the received IONM signals are still unknown.

Method

Prospective collection of data forms in 29 hospitals from 8,534 patients with 15,403 nerves at risk, who underwent surgery for benign and malignant goitre disorders between August 1999 and January 2001. IONM was performed by indirect stimulation via the vagal nerve and by direct recurrent laryngeal nerve (RLN) stimulation in 12,486 cases. IONM signals were compared with early (<14 days) and late (6 months) postoperative vocal cord function findings.

Results

The transient and permanent RLN palsy rate was 2.8% and 0.7%, respectively. Monitoring of the RLN function was significantly more reliable via the indirect IONM stimulation route than via the direct IONM stimulation route (specificity P<0.05). IONM by indirect stimulation via the vagal nerve reliably excluded postoperative, permanent, vocal cord palsy (specificity 97.6%, negative predictive value 99.6%). However, a changed IONM was insufficient to predict permanent RLN palsy (sensitivity 45.9%, positive predictive value 11.6%). IONM was not associated with increased general morbidity.

Conclusions

For intra-operative neuromonitoring, indirect stimulation of the RLN is superior to direct stimulation. An intact acoustic IONM signal is highly predictive of intact postoperative RLN function. When the IONM signal is abnormal or absent, a one-stage extensive thyroid resection should be performed only if the surgeon is absolutely convinced that the first RLN is not harmed or a total thyroidectomy is mandatory.

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Acknowledgements

The study was supported by a grant from the Inomed Company, Germany. The authors are grateful to all contributors to the multicentre study conducted by the German Society of Surgery. The study centre was the Department of Surgery, Martin Luther University of Halle-Wittenberg, Germany. The participants, in alphabetical order, are: Asperger W, St. Elisabeth Krankenhaus, Department of Surgery, Halle/Saale; Bähr R, Städtisches Klinikum Karlsruhe, Department of Surgery, Karlsruhe; Biehler A, Schlosspark Klinik, Department of Surgery, Berlin; Boese-Landgraf J, Klinikum Chemnitz, Department of Surgery, Chemnitz; Dommisch K, Klinikum Schwerin, Department of Surgery, Schwerin; Gastinger I, Carl Thiem Klinikum Cottbus, Department of Surgery, Cottbus; Hewel T, Oberschwaben Klinik Ravensburg, Krankenhaus Wangen, Department of Surgery, Wangen; Hothorn W, Kreiskrankenhaus Pössneck, Department of Surgery, Pössneck; Jähne J, Henriettenstift, Department of Surgery, Hanover; Kahle M, St. Elisabeth Krankenhaus, Department of Surgery, Bad Kissingen; Krause W, Klinikum Suhl, Department of Surgery, Suhl; Meyer K, Kreiskrankenhaus Bitterfeld/Wolfen, Department of Surgery, Wolfen; Mühlig HP, Kreiskrankenhaus Martha Maria, Department of Surgery, Munich; Neumann HJ, Städtisches Krankenhaus Martha Maria, Department of Ear, Nose and Throat Surgery, Halle/Saale; Neumann-Overholthaus EA, Hospital zum Heiligen Geist, Department of Surgery, Boppard; Richter C, Städtisches Krankenhaus Martha Maria, Department of Surgery, Halle/Saale; Rogenhofer H, Kreiskrankenhaus Roth, Department of Surgery, Roth; Schönfelder M, Südharz Krankenhaus Nordhausen, Department of Surgery, Nordhausen; Schwarze J, Kreiskrankenhaus Oschatz, Department of Surgery, Oschatz; Siggelkow G, Müritz Klinikum Waren, Department of Surgery, Waren; Skuballa A, Städtisches Klinikum St. Georg, Department of Thoracic and Vascular Surgery, Leipzig; Steinert F, Heliosklinik Schkeuditz, Department of Surgery, Schkeuditz; Timmermann W, University of Würzburg, Department of General Surgery, Würzburg; Voss J, St. Josef Stift, Department of Surgery, Dresden; Weimann A, Städtisches Klinikum St. Georg, Department of Surgery, Leipzig; Welter H, Carl von Basedow Klinikum, Department of Surgery, Merseburg; Wirth E, Kreiskrankenhaus Bischofswerda, Department of Surgery, Bischofswerda; Zaage J, BG Klinik Bergmannstrost, Department of General Surgery, Halle/Saale.

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Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany

    Oliver Thomusch, Carsten Sekulla, Andreas Machens & Henning Dralle

  2. Department of General Surgery, Albert-Ludwigs University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany

    Oliver Thomusch

  3. Department of Otolaryngology, Martha Maria Hospital, Halle, Germany

    Hans-Jürgen Neumann

  4. Department of Surgery, University of Würzburg, Würzburg, Germany

    Wolfgang Timmermann

Authors
  1. Oliver Thomusch
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  2. Carsten Sekulla
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  3. Andreas Machens
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  4. Hans-Jürgen Neumann
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  5. Wolfgang Timmermann
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  6. Henning Dralle
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Correspondence to Oliver Thomusch.

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Thomusch, O., Sekulla, C., Machens, A. et al. Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg 389, 499–503 (2004). https://doi.org/10.1007/s00423-003-0444-9

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  • DOI: https://doi.org/10.1007/s00423-003-0444-9

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