Academic Journal
Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy.
| Τίτλος: | Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy. |
|---|---|
| Συγγραφείς: | Zhang D; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China., Brucchi F; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Colombo C; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Division of Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy., Dionigi G; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., Sun H; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China. |
| Πηγή: | Head & neck [Head Neck] 2026 Oct; Vol. 48 (10), pp. 2627-2637. Date of Electronic Publication: 2026 Apr 09. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: John Wiley And Sons Country of Publication: United States NLM ID: 8902541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-0347 (Electronic) Linking ISSN: 10433074 NLM ISO Abbreviation: Head Neck Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York, NY : John Wiley And Sons Original Publication: New York, NY : J. Wiley, c1989- |
| Ιατρικοί όροι (MeSH): | Thyroidectomy*/adverse effects , Thyroidectomy*/methods , Vagus Nerve Injuries*/etiology , Vagus Nerve Injuries*/epidemiology , Vagus Nerve Injuries*/prevention & control , Vocal Cord Paralysis*/etiology , Monitoring, Intraoperative*/adverse effects , Intraoperative Neurophysiological Monitoring*/adverse effects , Intraoperative Complications*/etiology, Humans ; Female ; Retrospective Studies ; Electromyography ; Middle Aged ; Male ; Adult ; Aged ; Laryngoscopy |
| Περίληψη: | Objective: To characterize the patterns, mechanisms, and outcomes of vagus nerve (VN) injury associated with continuous intraoperative neuromonitoring (CIONM) during total thyroidectomy and to outline prevention strategies. Data Sources: A prospectively maintained thyroidectomy database (2014-2024), operative records, anesthesia charts, intraoperative electromyography (EMG) data, and standardized postoperative laryngoscopy. Review Methods: Retrospective identification of all postoperative VN injuries following total thyroidectomy with CIONM. VN injury was defined as new ipsilateral vocal fold palsy with abrupt or marked VN EMG loss not attributable to recurrent laryngeal nerve (RLN) trauma, confirmed by absent proximal and preserved distal stimulation. Variables included demographics, surgical approach, device type, VN topography, timing and mechanism of injury, EMG pattern, and recovery to 180 days. Incidence was calculated per nerve at risk. Analyses were descriptive. Results: Among 1060 thyroidectomies (2120 nerves at risk), nine VN injuries occurred (0.42%). Eight were transient and one permanent. Most injuries (89%) arose during initial carotid sheath dissection or probe application, particularly in posterior VN positions or short, thick necks. Older circumferential probes were more often involved. All lesions were segmental with preserved RLN EMG. No global VN damage, macroscopic disruption, thermal injury, or intraoperative hemodynamic instability was observed. Complete EMG loss predicted the only permanent palsy; partial amplitude/latency changes resolved. Early recognition, stopping manipulation, and timely voice therapy supported recovery. Conclusion: CIONM-related VN injury rate is low (0.4%), and most cases recovered in approximately 4 months. CIONM-related VN injury is usually related to nerve exposure rather than probe handling. (© 2026 Wiley Periodicals LLC.) |
| References: | R. Schneider, C. Sekulla, A. Machens, K. Lorenz, P. Nguyen Thanh, and H. Dralle, “Postoperative Vocal Fold Palsy in Patients Undergoing Thyroid Surgery With Continuous or Intermittent Nerve Monitoring,” British Journal of Surgery 102, no. 11 (2015): 1380–1387, https://doi.org/10.1002/bjs.9889. E. Phelan, R. Schneider, K. Lorenz, et al., “Continuous Vagal IONM Prevents Recurrent Laryngeal Nerve Paralysis by Revealing Initial EMG Changes of Impending Neuropraxic Injury: A Prospective, Multicenter Study,” Laryngoscope 124, no. 6 (2014): 1498–1505, https://doi.org/10.1002/lary.24550. R. Schneider, G. W. Randolph, C. Sekulla, et al., “Continuous Intraoperative Vagus Nerve Stimulation for Identification of Imminent Recurrent Laryngeal Nerve Injury,” Head & Neck 35, no. 11 (2013): 1591–1598, https://doi.org/10.1002/hed.23187. T. Wang, G. Dionigi, Y. Zhao, et al., “Tensile Strength Analysis of Automatic Periodic Stimulation for Continuous Intraoperative Neural Monitoring in a Piglet Model,” Scientific Reports 11, no. 1 (2021): 5898, https://doi.org/10.1038/s41598‐021‐84988‐y. R. Schneider, G. W. Randolph, M. Barczynski, et al., “Continuous Intraoperative Neural Monitoring of the Recurrent Nerves in Thyroid Surgery: A Quantum Leap in Technology,” Gland Surgery 5, no. 6 (2016): 607–616, https://doi.org/10.21037/gs.2016.11.10. A. Anuwong, M. Lavazza, H. Y. Kim, et al., “Recurrent Laryngeal Nerve Management in Thyroid Surgery: Consequences of Routine Visualization, Application of Intermittent, Standardized and Continuous Nerve Monitoring,” Updates in Surgery 68, no. 4 (2016): 331–341, https://doi.org/10.1007/s13304‐016‐0393‐9. A. Mangano, H. Y. Kim, C. W. Wu, et al., “Continuous Intraoperative Neuromonitoring in Thyroid Surgery: Safety Analysis of 400 Consecutive Electrode Probe Placements With Standardized Procedures,” Head and Neck 38, no. 1 (2016): E1568–E1574, https://doi.org/10.1002/hed.24280. A. Bacuzzi, H. Dralle, G. W. Randolph, et al., “Safety of Continuous Intraoperative Neuromonitoring (C‐IONM) in Thyroid Surgery,” World Journal of Surgery 40, no. 3 (2016): 768–769, https://doi.org/10.1007/s00268‐015‐3288‐x. G. Dionigi, G. Donatini, L. Boni, et al., “Continuous Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery: A Critical Appraisal,” International Journal of Surgery 11, no. 1 (2013): S44–S46, https://doi.org/10.1016/S1743‐9191(13)60014‐X. R. Schneider, A. Machens, M. Bucher, C. Raspé, K. Heinroth, and H. Dralle, “Continuous Intraoperative Monitoring of Vagus and Recurrent Laryngeal Nerve Function in Patients With Advanced Atrioventricular Block,” Langenbeck's Archives of Surgery 401, no. 4 (2016): 551–556, https://doi.org/10.1007/s00423‐016‐1433‐0. W. Liddy, S. R. Barber, M. Cinquepalmi, et al., “The Electrophysiology of Thyroid Surgery: Electrophysiologic and Muscular Responses With Stimulation of the Vagus Nerve, Recurrent Laryngeal Nerve, and External Branch of the Superior Laryngeal Nerve,” Laryngoscope 127, no. 3 (2017): 764–771, https://doi.org/10.1002/lary.26147. G. Dionigi, F. Y. Chiang, S. Rausei, et al., “Surgical Anatomy and Neurophysiology of the Vagus Nerve (VN) for Standardised Intraoperative Neuromonitoring (IONM) of the Inferior Laryngeal Nerve (ILN) During Thyroidectomy,” Langenbeck's Archives of Surgery 395, no. 7 (2010): 893–899, https://doi.org/10.1007/s00423‐010‐0693‐3. W. Lamadé, U. Meyding‐Lamadé, C. Buchhold, et al., “Erstes Kontinuierliches Nerven‐Monitoring in Der Schilddrüsenchirurgie [First Continuous Nerve Monitoring in Thyroid Gland Surgery],” Der Chirurg 71, no. 5 (2000): 551–557, https://doi.org/10.1007/s001040051101. D. Ku, M. Hui, P. Cheung, et al., “Meta‐Analysis on Continuous Nerve Monitoring in Thyroidectomies,” Head and Neck 43, no. 12 (2021): 3966–3978, https://doi.org/10.1002/hed.26828. D. Zhang, C. Wang, T. Wang, et al., “Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo‐Breast Thyroid Surgery,” Frontiers in Endocrinology 12 (2022): 817026, https://doi.org/10.3389/fendo.2021.817026. Y. H. Uen, C. W. Wu, K. S. Wen, et al., “Correction: Percutaneous Continuous Vagal Stimulation Provided Superior Neuromonitoring Over the Peroral Electrode in Transoral Thyroidectomy,” Surgical Endoscopy 39 (2025): 6275, https://doi.org/10.1007/s00464‐025‐12105‐5. J. D. Kakisis, C. N. Antonopoulos, G. Mantas, K. G. Moulakakis, G. Sfyroeras, and G. Geroulakos, “Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends,” European Journal of Vascular and Endovascular Surgery 53, no. 3 (2017): 320–335, https://doi.org/10.1016/j.ejvs.2016.12.026. J. van Schooten, J. Smeets, S. M. van Kuijk, et al., “Surgical Complications of Vagus Nerve Stimulation Surgery: A 14‐Years Single‐Center Experience,” Brain and Spine 4 (2023): 102733, https://doi.org/10.1016/j.bas.2023.102733. G. W. Randolph, H. Dralle, International Intraoperative Monitoring Study Group, et al., “Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement,” Laryngoscope 121, no. 1 (2011): S1–S16, https://doi.org/10.1002/lary.21119. T. Y. Huang, H. Y. Tseng, F. Frattini, et al., “The INMSG Survey on the Loss of Signal Management on the First Side During Planned Bilateral Thyroid Surgery,” Journal of Otolaryngology–Head and Neck Surgery 53 (2024): 19160216241265684, https://doi.org/10.1177/19160216241265684. R. Schneider, G. W. Randolph, G. Dionigi, et al., “International Neural Monitoring Study Group Guideline 2018 Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal,” Laryngoscope 128, no. Suppl 3 (2018): S1–S17, https://doi.org/10.1002/lary.27359. C. W. Wu, G. W. Randolph, M. Barczyński, et al., “Training Courses in Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery the INMSG Consensus Statement,” Frontiers in Endocrinology 12 (2021): 705346, https://doi.org/10.3389/fendo.2021.705346. C. W. Wu, G. Dionigi, M. Barczynski, et al., “International Neuromonitoring Study Group Guidelines 2018: Part II: Optimal Recurrent Laryngeal Nerve Management for Invasive Thyroid Cancer‐Incorporation of Surgical, Laryngeal, and Neural Electrophysiologic Data,” Laryngoscope 128, no. Suppl 3 (2018): S18–S27, https://doi.org/10.1002/lary.27360. R. Schneider, G. Randolph, G. Dionigi, et al., “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, no. 5 (2016): 1260–1266, https://doi.org/10.1002/lary.25807. G. Dionigi, L. Boni, F. Rovera, S. Rausei, P. Castelnuovo, and R. Dionigi, “Postoperative Laryngoscopy in Thyroid Surgery: Proper Timing to Detect Recurrent Laryngeal Nerve Injury,” Langenbeck's Archives of Surgery 395, no. 4 (2010): 327–331, https://doi.org/10.1007/s00423‐009‐0581‐x. S. Bidault, E. Girard, M. Attard, et al., “Preoperative Ultrasound Mapping of the Vagus Nerve in Thyroid Surgery,” Gland Surgery 11, no. 1 (2022): 91–99, https://doi.org/10.21037/gs‐21‐580. |
| Contributed Indexing: | Keywords: continuous intraoperative neuromonitoring; dysphonia; thyroidectomy; vagus nerve injury |
| Entry Date(s): | Date Created: 20260410 Date Completed: 20260922 Latest Revision: 20260922 |
| Update Code: | 20260922 |
| DOI: | 10.1002/hed.70276 |
| PMID: | 41958016 |
| Βάση Δεδομένων: | MEDLINE |
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| Items | – Name: Title Label: Title Group: Ti Data: Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AU" term="%22Zhang+D%22">Zhang D</searchLink>; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China.<br /><searchLink fieldCode="AU" term="%22Brucchi+F%22">Brucchi F</searchLink>; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.<br /><searchLink fieldCode="AU" term="%22Colombo+C%22">Colombo C</searchLink>; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.; Division of Endocrinology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.<br /><searchLink fieldCode="AU" term="%22Dionigi+G%22">Dionigi G</searchLink>; Division of General Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Auxologico Italiano, Milan, Italy.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.<br /><searchLink fieldCode="AU" term="%22Sun+H%22">Sun H</searchLink>; Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Thyroid Disease, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun City, Jilin Province, China. – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%228902541%22">Head & neck</searchLink> [Head Neck] 2026 Oct; Vol. 48 (10), pp. 2627-2637. <i>Date of Electronic Publication: </i>2026 Apr 09. – Name: TypePub Label: Publication Type Group: TypPub Data: Journal Article – Name: Language Label: Language Group: Lang Data: English – Name: TitleSource Label: Journal Info Group: Src Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22John+Wiley+And+Sons%22">John Wiley And Sons </searchLink><i>Country of Publication: </i>United States <i>NLM ID: </i>8902541 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1097-0347 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2210433074%22">10433074 </searchLink><i>NLM ISO Abbreviation: </i>Head Neck <i>Subsets: </i>MEDLINE – Name: PublisherInfo Label: Imprint Name(s) Group: PubInfo Data: <i>Publication</i>: New York, NY : John Wiley And Sons<br /><i>Original Publication</i>: New York, NY : J. Wiley, c1989- – Name: SubjectMESH Label: MeSH Terms Group: Su Data: <searchLink fieldCode="MM" term="%22Thyroidectomy%22">Thyroidectomy*</searchLink>/<searchLink fieldCode="MM" term="%22Thyroidectomy+adverse+effects%22">adverse effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Thyroidectomy%22">Thyroidectomy*</searchLink>/<searchLink fieldCode="MM" term="%22Thyroidectomy+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries%22">Vagus Nerve Injuries*</searchLink>/<searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries+etiology%22">etiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries%22">Vagus Nerve Injuries*</searchLink>/<searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries%22">Vagus Nerve Injuries*</searchLink>/<searchLink fieldCode="MM" term="%22Vagus+Nerve+Injuries+prevention+%26+control%22">prevention & control</searchLink> <br /><searchLink fieldCode="MM" term="%22Vocal+Cord+Paralysis%22">Vocal Cord Paralysis*</searchLink>/<searchLink fieldCode="MM" term="%22Vocal+Cord+Paralysis+etiology%22">etiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Monitoring%2C+Intraoperative%22">Monitoring, Intraoperative*</searchLink>/<searchLink fieldCode="MM" term="%22Monitoring%2C+Intraoperative+adverse+effects%22">adverse effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+adverse+effects%22">adverse effects</searchLink> <br /><searchLink fieldCode="MM" term="%22Intraoperative+Complications%22">Intraoperative Complications*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Complications+etiology%22">etiology</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Retrospective+Studies%22">Retrospective Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Electromyography%22">Electromyography</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Laryngoscopy%22">Laryngoscopy</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: Objective: To characterize the patterns, mechanisms, and outcomes of vagus nerve (VN) injury associated with continuous intraoperative neuromonitoring (CIONM) during total thyroidectomy and to outline prevention strategies.<br />Data Sources: A prospectively maintained thyroidectomy database (2014-2024), operative records, anesthesia charts, intraoperative electromyography (EMG) data, and standardized postoperative laryngoscopy.<br />Review Methods: Retrospective identification of all postoperative VN injuries following total thyroidectomy with CIONM. VN injury was defined as new ipsilateral vocal fold palsy with abrupt or marked VN EMG loss not attributable to recurrent laryngeal nerve (RLN) trauma, confirmed by absent proximal and preserved distal stimulation. Variables included demographics, surgical approach, device type, VN topography, timing and mechanism of injury, EMG pattern, and recovery to 180 days. Incidence was calculated per nerve at risk. Analyses were descriptive.<br />Results: Among 1060 thyroidectomies (2120 nerves at risk), nine VN injuries occurred (0.42%). Eight were transient and one permanent. Most injuries (89%) arose during initial carotid sheath dissection or probe application, particularly in posterior VN positions or short, thick necks. Older circumferential probes were more often involved. All lesions were segmental with preserved RLN EMG. No global VN damage, macroscopic disruption, thermal injury, or intraoperative hemodynamic instability was observed. Complete EMG loss predicted the only permanent palsy; partial amplitude/latency changes resolved. Early recognition, stopping manipulation, and timely voice therapy supported recovery.<br />Conclusion: CIONM-related VN injury rate is low (0.4%), and most cases recovered in approximately 4 months. CIONM-related VN injury is usually related to nerve exposure rather than probe handling.<br /> (© 2026 Wiley Periodicals LLC.) – Name: Ref Label: References Group: RefInfo Data: R. Schneider, C. Sekulla, A. Machens, K. Lorenz, P. Nguyen Thanh, and H. Dralle, “Postoperative Vocal Fold Palsy in Patients Undergoing Thyroid Surgery With Continuous or Intermittent Nerve Monitoring,” British Journal of Surgery 102, no. 11 (2015): 1380–1387, https://doi.org/10.1002/bjs.9889.<br />E. Phelan, R. Schneider, K. Lorenz, et al., “Continuous Vagal IONM Prevents Recurrent Laryngeal Nerve Paralysis by Revealing Initial EMG Changes of Impending Neuropraxic Injury: A Prospective, Multicenter Study,” Laryngoscope 124, no. 6 (2014): 1498–1505, https://doi.org/10.1002/lary.24550.<br />R. Schneider, G. W. Randolph, C. Sekulla, et al., “Continuous Intraoperative Vagus Nerve Stimulation for Identification of Imminent Recurrent Laryngeal Nerve Injury,” Head & Neck 35, no. 11 (2013): 1591–1598, https://doi.org/10.1002/hed.23187.<br />T. Wang, G. Dionigi, Y. Zhao, et al., “Tensile Strength Analysis of Automatic Periodic Stimulation for Continuous Intraoperative Neural Monitoring in a Piglet Model,” Scientific Reports 11, no. 1 (2021): 5898, https://doi.org/10.1038/s41598‐021‐84988‐y.<br />R. Schneider, G. W. Randolph, M. Barczynski, et al., “Continuous Intraoperative Neural Monitoring of the Recurrent Nerves in Thyroid Surgery: A Quantum Leap in Technology,” Gland Surgery 5, no. 6 (2016): 607–616, https://doi.org/10.21037/gs.2016.11.10.<br />A. Anuwong, M. Lavazza, H. Y. Kim, et al., “Recurrent Laryngeal Nerve Management in Thyroid Surgery: Consequences of Routine Visualization, Application of Intermittent, Standardized and Continuous Nerve Monitoring,” Updates in Surgery 68, no. 4 (2016): 331–341, https://doi.org/10.1007/s13304‐016‐0393‐9.<br />A. Mangano, H. Y. Kim, C. W. Wu, et al., “Continuous Intraoperative Neuromonitoring in Thyroid Surgery: Safety Analysis of 400 Consecutive Electrode Probe Placements With Standardized Procedures,” Head and Neck 38, no. 1 (2016): E1568–E1574, https://doi.org/10.1002/hed.24280.<br />A. Bacuzzi, H. Dralle, G. W. Randolph, et al., “Safety of Continuous Intraoperative Neuromonitoring (C‐IONM) in Thyroid Surgery,” World Journal of Surgery 40, no. 3 (2016): 768–769, https://doi.org/10.1007/s00268‐015‐3288‐x.<br />G. Dionigi, G. Donatini, L. Boni, et al., “Continuous Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery: A Critical Appraisal,” International Journal of Surgery 11, no. 1 (2013): S44–S46, https://doi.org/10.1016/S1743‐9191(13)60014‐X.<br />R. Schneider, A. Machens, M. Bucher, C. Raspé, K. Heinroth, and H. Dralle, “Continuous Intraoperative Monitoring of Vagus and Recurrent Laryngeal Nerve Function in Patients With Advanced Atrioventricular Block,” Langenbeck's Archives of Surgery 401, no. 4 (2016): 551–556, https://doi.org/10.1007/s00423‐016‐1433‐0.<br />W. Liddy, S. R. Barber, M. Cinquepalmi, et al., “The Electrophysiology of Thyroid Surgery: Electrophysiologic and Muscular Responses With Stimulation of the Vagus Nerve, Recurrent Laryngeal Nerve, and External Branch of the Superior Laryngeal Nerve,” Laryngoscope 127, no. 3 (2017): 764–771, https://doi.org/10.1002/lary.26147.<br />G. Dionigi, F. Y. Chiang, S. Rausei, et al., “Surgical Anatomy and Neurophysiology of the Vagus Nerve (VN) for Standardised Intraoperative Neuromonitoring (IONM) of the Inferior Laryngeal Nerve (ILN) During Thyroidectomy,” Langenbeck's Archives of Surgery 395, no. 7 (2010): 893–899, https://doi.org/10.1007/s00423‐010‐0693‐3.<br />W. Lamadé, U. Meyding‐Lamadé, C. Buchhold, et al., “Erstes Kontinuierliches Nerven‐Monitoring in Der Schilddrüsenchirurgie [First Continuous Nerve Monitoring in Thyroid Gland Surgery],” Der Chirurg 71, no. 5 (2000): 551–557, https://doi.org/10.1007/s001040051101.<br />D. Ku, M. Hui, P. Cheung, et al., “Meta‐Analysis on Continuous Nerve Monitoring in Thyroidectomies,” Head and Neck 43, no. 12 (2021): 3966–3978, https://doi.org/10.1002/hed.26828.<br />D. Zhang, C. Wang, T. Wang, et al., “Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo‐Breast Thyroid Surgery,” Frontiers in Endocrinology 12 (2022): 817026, https://doi.org/10.3389/fendo.2021.817026.<br />Y. H. Uen, C. W. Wu, K. S. Wen, et al., “Correction: Percutaneous Continuous Vagal Stimulation Provided Superior Neuromonitoring Over the Peroral Electrode in Transoral Thyroidectomy,” Surgical Endoscopy 39 (2025): 6275, https://doi.org/10.1007/s00464‐025‐12105‐5.<br />J. D. Kakisis, C. N. Antonopoulos, G. Mantas, K. G. Moulakakis, G. Sfyroeras, and G. Geroulakos, “Cranial Nerve Injury After Carotid Endarterectomy: Incidence, Risk Factors, and Time Trends,” European Journal of Vascular and Endovascular Surgery 53, no. 3 (2017): 320–335, https://doi.org/10.1016/j.ejvs.2016.12.026.<br />J. van Schooten, J. Smeets, S. M. van Kuijk, et al., “Surgical Complications of Vagus Nerve Stimulation Surgery: A 14‐Years Single‐Center Experience,” Brain and Spine 4 (2023): 102733, https://doi.org/10.1016/j.bas.2023.102733.<br />G. W. Randolph, H. Dralle, International Intraoperative Monitoring Study Group, et al., “Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement,” Laryngoscope 121, no. 1 (2011): S1–S16, https://doi.org/10.1002/lary.21119.<br />T. Y. Huang, H. Y. Tseng, F. Frattini, et al., “The INMSG Survey on the Loss of Signal Management on the First Side During Planned Bilateral Thyroid Surgery,” Journal of Otolaryngology–Head and Neck Surgery 53 (2024): 19160216241265684, https://doi.org/10.1177/19160216241265684.<br />R. Schneider, G. W. Randolph, G. Dionigi, et al., “International Neural Monitoring Study Group Guideline 2018 Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal,” Laryngoscope 128, no. Suppl 3 (2018): S1–S17, https://doi.org/10.1002/lary.27359.<br />C. W. Wu, G. W. Randolph, M. Barczyński, et al., “Training Courses in Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery the INMSG Consensus Statement,” Frontiers in Endocrinology 12 (2021): 705346, https://doi.org/10.3389/fendo.2021.705346.<br />C. W. Wu, G. Dionigi, M. 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Attard, et al., “Preoperative Ultrasound Mapping of the Vagus Nerve in Thyroid Surgery,” Gland Surgery 11, no. 1 (2022): 91–99, https://doi.org/10.21037/gs‐21‐580. – Name: SubjectMinor Label: Contributed Indexing Group: Data: <i>Keywords: </i>continuous intraoperative neuromonitoring; dysphonia; thyroidectomy; vagus nerve injury – Name: DateEntry Label: Entry Date(s) Group: Date Data: <i>Date Created: </i>20260410 <i>Date Completed: </i>20260922 <i>Latest Revision: </i>20260922 – Name: DateUpdate Label: Update Code Group: Date Data: 20260922 – Name: DOI Label: DOI Group: ID Data: 10.1002/hed.70276 – Name: AN Label: PMID Group: ID Data: 41958016 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1002/hed.70276 Languages: – Code: eng Text: English PhysicalDescription: Pagination: StartPage: 2627 Subjects: – SubjectFull: Humans Type: general – SubjectFull: Female Type: general – SubjectFull: Retrospective Studies Type: general – SubjectFull: Electromyography Type: general – SubjectFull: Middle Aged Type: general – SubjectFull: Male Type: general – SubjectFull: Adult Type: general – SubjectFull: Aged Type: general – SubjectFull: Laryngoscopy Type: general – SubjectFull: Thyroidectomy adverse effects Type: general – SubjectFull: Thyroidectomy methods Type: general – SubjectFull: Vagus Nerve Injuries etiology Type: general – SubjectFull: Vagus Nerve Injuries epidemiology Type: general – SubjectFull: Vagus Nerve Injuries prevention & control Type: general – SubjectFull: Vocal Cord Paralysis etiology Type: general – SubjectFull: Monitoring, Intraoperative adverse effects Type: general – SubjectFull: Intraoperative Neurophysiological Monitoring adverse effects Type: general – SubjectFull: Intraoperative Complications etiology Type: general Titles: – TitleFull: Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Zhang D – PersonEntity: Name: NameFull: Brucchi F – PersonEntity: Name: NameFull: Colombo C – PersonEntity: Name: NameFull: Dionigi G – PersonEntity: Name: NameFull: Sun H IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Text: 2026 Oct Type: published Y: 2026 Identifiers: – Type: issn-electronic Value: 1097-0347 Numbering: – Type: volume Value: 48 – Type: issue Value: 10 Titles: – TitleFull: Head & neck Type: main |
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