Abstract
Intraoperative neuromonitoring (IONM) through vagus nerve (VN) stimulation in thyroid surgery provides indisputable recurrent laryngeal nerve (RLN) identification and comprehensive functional assessment of neural integrity during the process of thyroid resection. Neurostimulation of the RLN and VN generates an electromyogram with audio-tone. Relevant information regarding neural integrity using IONM is gained by observing the EMG parameters of amplitude, latency, and signal configuration. Relevant changes and corresponding surgical maneuvers must be considered to react timely and thereby possibly prevent neural injury. The hallmark of neural injury that corresponds with postoperative vocal cord dysfunction is the loss of signal (LOS) without recovery during IONM-guided thyroid surgery. Therefore, after LOS on the first side operated, staging of the planned bilateral surgery by postponing the second side until RLN function is restored is recommended. In this chapter, detailed definitions of the relevant IONM parameters and LOS are provided, and a description of IONM application with procedural recommendations is presented.
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