Increased prediction of right nonrecurrent laryngeal nerve in thyroid surgery using preoperative computed tomography with intraoperative neuromonitoring identification

World Journal of Surgical Oncology

Research

Xian Zou¹  Ye-hui Zhou²  Er-li Gao²  Hong-geng Guan²  Jin Lan²  Dao-hai Xie³ 

[1] Department of General Surgery, Jiangyuan Hospital Affiliated to Jiangsu Institution of Nuclear Medicine (Key Laboratory of Nuclear Medicine, Ministry of Health/Jiangsu Key Laboratory of Molecular Nuclear Medicine), 20 Qianrong Rd, 214063, Wuxi, Jiangsu, People’s Republic of China;Department of General Surgery, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, 215006, Suzhou, Jiangsu, People’s Republic of China;Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, 215006, Suzhou, Jiangsu, People’s Republic of China;

关键词: nonrecurrent laryngeal nerve;    thyroid surgery;    CT;    IONM;   

DOI  :  10.1186/1477-7819-12-262

 received in 2013-12-25, accepted in 2014-08-06,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundA nonrecurrent laryngeal nerve (NRLN) is a rare but potentially serious anatomical variant. Although the incidence is reported to be 0.3% to 1.3%, it carries a much higher risk of palsy during thyroid surgery. The objective of this study is to investigate the usefulness of computed tomography (CT) for preoperative identification and intraoperative neuromonitoring identification (IONM) of NRLN in thyroid cancer patients.MethodsThe preoperative neck CT scans from 1,574 patients who needed thyroid surgery were examined. Absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria were defined as positive with NRLN. Systematic intraoperative neuromonitoring (IONM) was also carried out for these 1,574 patients to localize and identify NRLN. A negative electromyography (EMG) response from lower vagal stimulation but a positive EMG response from the upper position indicated the occurrence of an NRLN.ResultsNine NRLN (0.57%) were intraoperatively identified out of the 1,574 patients, and no patient with a NRLN showed preoperative clinical symptoms related to NRLN. Prior to the operation, surgeons identified only seven suspected NRLN cases based on identification of arteria lusoria. But a review of CT scans revealed that all cases could be identified by vascular anomalies. All patients were successfully detected at an early stage of operation using intraoperative neuromonitoring (IONM). Postoperative vocal cord function was normal in all patients.ConclusionsCT of the neck is a reliable method for predicting NRLN before thyroid cancer surgery. However, some image features can be easily missed. Neurophysiology helps the surgeon to identify the NRLNs more precisely. Combining the two evaluation methods may decrease the incidence of nerve palsy, especially in cases of NRLN. Considering that CT is expensive, requires an X-ray, and achieves less information than ultrasound (US) concerning thyroid nodules, we suggest that applying US and IONM is more reasonable.

【 授权许可】

Unknown   
© Gao et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.