Continuous intraoperative neuromonitoring

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The continuous intraoperative nerve monitoring (short: CIONM ) is an evolution of intraoperative nerve monitoring and allows for effective real-time monitoring of the recurrent laryngeal nerve throughout its anatomical course. The slightest changes in the functionality of the nerve can be detected and injuries to the recurrent laryngeal nerve can be prevented during thyroid surgery .

development

The first description of continuous neuromonitoring took place in the mid-1990s under Prof. Dr. Wolfram Lamadé. With the double balloon tube it was possible in 1995 for the first time to stimulate the recurrent laryngeal nerve transtracheally with the help of electrodes on the tube and to derive the triggered muscle action potentials at the glottis. In 2007 a new concept of continuous neuromonitoring using a flexible vagus probe was presented. Various further developments in recent years have made the vagus probe a helpful, safe and reliable tool for the surgeon in thyroid operations .

advantages

Continuous intraoperative neuromonitoring is a new method for protecting the recurrent laryngeal nerve during thyroid surgery . With this process it is possible for the first time to produce a continuous, i.e. H. to ensure permanent, safe and stable monitoring of the vocal cord nerves throughout the operation. In addition to the intraoperative representation of the anatomical course and the associated protection of the nerves, a prediction of the postoperative vocal cord function is also possible during the operation. The new neuromonitoring process is intended to change the operative strategy in favor of an even gentler approach, which is intended to benefit problem cases and tumor patients in particular.

Individual evidence

  1. ↑ W. Lamadé, W. Fogel, K. Rieke, N. Senninger, C. Herfarth: Intraoperative monitoring of the recurrent laryngeal nerve. A new method. In: surgeon. Volume 67, 1996, pp. 451-454.
  2. ↑ W. Lamadé, U. Meyding-Lamadé, E. dog, N. Senninger, C. Herfarth: Transtracheal monitoring of the recurrent laryngeal nerve. Prototype of a new tube. In: surgeon. Volume 68, 1997, pp. 193-195.
  3. ↑ R. Brandner, W. Lamadé, H. Dick House: Intraoperative monitoring of the recurrent laryngeal nerve in thyroid operations. In: Biomed Tech (Berl). Volume 43, 1998, pp. 142-143.
  4. ↑ W. Lamadé, R. Brandner, M. Brauer, E. dog, E. Clear, C. Herfarth: Continuous monitoring of the recurrent laryngeal nerve. In: Langenbecks Arch Chir Suppl Kongressbd. Volume 115, 1998, pp. 1055-1057.
  5. ↑ W. Lamadé, U. Meyding-Lamadé, C. Buchhold, M. Brauer, R. Brandner, V. Uttenweiler, J. Motsch, E. Clear, C. Herfarth: First continuous nerve monitoring in thyroid gland surgery. In: surgeon. Volume 71, 2000, pp. 551-557.
  6. ↑ W. Lamadé, C. Ulmer, A. Seimer, V. Molnar, U. Meyding-Lamadé, KP Thon, KP Koch: A new system for continuous recurrent laryngeal nerve monitoring. In: Minim Invasive Ther Allied Technol. Volume 16, 2007, pp. 149-154.
  7. ↑ C. Ulmer, KP Koch, A. Seimer, V. Molnar, U. Meyding-Lamadé, KP Thon, W. Lamadé: Real-time monitoring of the recurrent laryngeal nerve: An observational clinical trial. In: Surgery. Volume 143, 2007, pp. 359-365.
  8. ↑ H. Dralle, K. Lorenz: Intraoperative neuromonitoring in thyroid operations. In: surgeon. Volume 81, 2010, pp. 612-619.
  9. ↑ C. Friedrich, C. Ulmer, F. Rieber, E. Kern, A. Kohler, K. Schymik, KP Thon, W. Lamadé: Safety Analysis of Vagal Nerve Stimulation for Continuous Nerve Monitoring During Thyroid Surgery. In: Laryngoscope. Volume 122, 2012, pp. 1979-1987.
  10. ↑ J. Jonas: The assessment of signal changes during continuous neuromonitoring in thyroid surgery. In: Zentralbl Chir. Volume 135, 2010, pp. 262-266.
  11. ↑ W. Lamadé, C. Ulmer, F. Rieber, C. Frederick, KP Koch, KP Thon: New backstrap vagus electrode for continuous intraoperative neurological monitoring in thyroid surgery. In: Surgical Innovation. Volume 18, 2011, pp. 206-213.
  12. ↑ GW Randolph, H. Dralle with the International Intraoperative Monitoring Study Group: H. Abdullah, M. Barczynski, R. Bellantone, M. Brauckhoff, B. Carnaille, S. Cherenko, FY Chiang, G. Dionigi, C. Finck, D. Hartl, D. Kamani, K. Lorenz, P. Miccolli, R. Mihai, A. Miyauchi, L. Orloff, N. Perrier, MD Poveda, A. Romanchishen, J. Serpell, A. Sitges-Serra, T. Sloan, S. Van Slycke, S. Snyder, H. Takami, E. Volpi, G. Woodson: Electrophysiologic Recurrent Laryngeal Nerve Monitoring During Thyroid and Parathyroid Surgery: International Standards Guideline Statement. In: The Laryngoscope. Volume 121, 2011, pp. 1-16.
  13. ↑ R. Schneider, J. Przybyl, M. Hermann, J. Hauss, S. Jonas, S. Leinung: A new anchor electrode design for continuous neuro monitoring of the recurrent laryngeal nerve by vagal nerve stimulations. In: Langenbecks Arch Surg. Volume 394, 2009, pp. 903-910.
  14. ↑ R. Schneider, W. Lamadé, M. Hermann, P. Goretzki, W. Timmermann, J. Hauss, p Leinung: Continuous intraoperative nerve monitoring of the recurrent laryngeal nerve in thyroid surgery (CIONM) - Where do we stand? An update on the European Symposium on Continuous Neuromonitoring in Thyroid Surgery. In: Zentralbl Chir. Volume 137, 2012, pp. 88-90.
  15. ^ R. Schneider, C. Bures, K. Lorenz, H. Dralle, M. Freissmuth, M. Hermann: Evolution of Nerve Injury with Unexpected EMG Signal Recovery in Thyroid Surgery Using Continuous Intraoperative Neuromonitoring. In: World Journal of Surgery Volume 37, 2013, pp. 364-368.
  16. ↑ C. Ulmer, C. Friedrich, A. Kohler, F. Rieber, T. Basar, M. Deuschle, KP Thon, W. Lamadé: Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery. In: Head & Neck . Volume 33, 2011, pp. 976-984.
  17. ↑ W. Lamadé, C. Ulmer, C. Friedrich, F. Rieber, K. Schymik, HM Gemkow, KP Koch, T. Göttsche, KP Thon: Signal stability as a basic requirement for continuous intraoperative neuromonitoring. In: surgeon. Volume 82, 2011, pp. 913-920.