Atlas of Intraoperative Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery

Description

This comprehensive atlas is the modern, state-of-the-art guide for intraoperative neurophysiologic monitoring (IONM) and management of the recurrent laryngeal nerve, vagus nerve and other cranial nerves at risk during thyroid, parathyroid and modified radical neck dissection surgery. Based on real-time electrophysiologic images, it will assist the surgeon in the decision-making process by incorporating important information related to the identification of the nerves and their functional status, aiding in the interpretation and improvement of the quality of neural monitoring and reducing inappropriate variations in monitoring technique. Utilization of IONM enables the surgeon to interrogate nerve anatomy and function with immediate quantitative feedback, thereby augmenting surgical training, and importantly, surgical skills and sound anatomic knowledge remain prerequisite and are not supplanted by IONM use.  Authored by experts in the field, Atlas of Intraoperative Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery will be the gold-standard text for IONM for endocrine surgeons, otolaryngology surgeons, neurophysiologists, and head and neck surgeons, as well as fellows and residents in these areas. Preface Acknowledgments Contents Contributors 1: Anatomy and Function of Cranial and Neck Nerves Introduction Summary of Cranial Nerves I–VI, VII, and IX CNI: The Olfactory Nerve CNII: The Optic Nerve CNIII: The Oculomotor Nerve CN IV: The Trochlear Nerve CN V: The Trigeminal Nerve CN VI: The Abducens Nerve CN IX: The Glossopharyngeal Nerve CN VII: The Facial Nerve Anatomy Function CN X: The Vagus Nerve Anatomy Function Branches of the Vagus Nerve The Recurrent Laryngeal Nerve (RLN) Superior Laryngeal Nerve (SLN) The Internal Branch of the Superior Laryngeal Nerve (IBSLN) The External Branch of the Superior Laryngeal Nerve (EBSLN) Communicating “Anastomoses” Between SLN and RLN Galen’s Anastomosis Extra-Laryngeal Anastomosis Between the RLN and the EBSLN CN XI: The Spinal Accessory Nerve CN XII: The Hypoglossal Nerve Phrenic Nerve References 2: Electrophysiological Equipment Medtronic NIM 3.0 System NIM Vital NIM TriVantage EMG Tubes Inomed C2 Explore Cadwell Cascade IOMAX CadX Cascade Surgical Studio (CSS) References 3: Intraoperative Neurophysiologic Monitoring: A Neurologic Perspective References 4: Intraoperative Neurophysiological Monitoring Anesthesia Perspective Introduction Preoperative Assessment Intraoperative Management Anesthesia Emergence References 5: Intraoperative Neurophysiological Monitoring Surgical Perspective Introduction Rationale for Intraoperative Nerve Monitoring Preventing Vocal Fold Injury Types of Intraoperative Nerve Monitoring Safety of Intraoperative Nerve Monitoring Limitations Conclusions References 6: Electrophysiologic RLN and Vagal Monitoring During Thyroid and Parathyroid Surgery Introduction Brief History of IONM Prevalence and Patterns of IONM Use Role in Education Rationale and Indications for IONM Rates and Impact of Vocal Cord Paralysis Role of Preoperative Laryngeal Examination Evidence Basis for Benefit of IONM IONM Standards of Use and Applications Surgical Anatomy of the Vagus/RLN Normal Anatomy Variant Anatomy Standard Set-up and Troubleshooting Standard Set-up Signal Interpretation and Troubleshooting RLN Injury and Loss of Signal Mechanisms of RLN Injury Loss of Signal IONM and RLN Invasion Neuromonitoring in Parathyroid Surgery Conclusions References 7: External Branch of the Superior Laryngeal Nerve (EBSLN) Monitoring During Thyroid and Parathyroid Surgery Introduction Surgical Anatomy How to Avoid Injury to the EBSLN During Thyroidectomy How to Diagnose the EBSLN Paralysis? Intraoperative Monitoring of the EBSLN Relevance of EBSLN Intraoperative Monitoring Does EBSLN Intraoperative Monitoring Reduce the Frequency of Nerve Injury? Frequency of Use of EBSLN Intraoperative Nerve Monitoring Normative Features of EBSLN Intraoperative Monitoring Prognostic Parameters of the EBSLN and Change in Voice Quality Postoperatively Take-Home Messages References 8: Intraoperative Neurophysiologic Monitoring for the Recurrent Laryngeal Nerve: Case Illustrations Further Reading 9: Intraoperative Neurophysiological Monitoring for the External Branch of the Superior Laryngeal Nerve: Case Illustrations Further Reading 10: Intraoperative Neurophysiological Monitoring for the Vagus Nerve: Case Illustrations Further Reading 11: Intraoperative Neurophysiological Monitoring for the Spinal Accessory Nerve: Case Illustrations Further Reading 12: Intraoperative Neurophysiological Monitoring for the Hypoglossal Nerve: Case Illustrations Further Reading 13: Intraoperative Neurophysiological Monitoring for the Phrenic Nerve: Case Illustrations Further Reading 14: Continuous Intraoperative Neuromonitoring in Thyroid Surgery Introduction Prerequisites for CIONM Evaluation of VC Movement Concept of the Dominant Side Informed Consent CIONM Equipment Anesthesia and Endotracheal Tube Positioning Procedure Evaluation of EMG Data Impending Neuronal Damage Artifacts Signal Recovery Definite Loss of EMG Signal and Staged Thyroidectomy References 15: Intraoperative Neuromonitoring of the RLNs During TOETVA Procedures Introduction The RLN Approach and Dissection in TOETVA The RLN Injury During TOETVA 2 The EBSLN Approach and Dissection in TOETVA IONM Key Steps in TOETVA IONM Procedure with Long Stimulating Probe IONM Guidance with Percutaneous Stimulating Probe IONM Operative Strategy with Dissecting and Stimulating Instruments Advanced Monitoring with C-IONM IONM Limits in TOETVA References Index