Unintended Consequences: Vagal Nerve Injury During Continuous Neuromonitoring in Thyroidectomy

IF 2.2 3区医学 Q1 OTORHINOLARYNGOLOGY

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck Pub Date : 2026-09-22 Epub Date: 2026-04-09 DOI:10.1002/hed.70276

Daqi Zhang, Francesco Brucchi, Carla Colombo, Gianlorenzo Dionigi, Hui Sun

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引用次数: 0

Abstract

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.

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意想不到的后果：甲状腺切除术中持续神经监测期间的迷走神经损伤。

目的：探讨全甲状腺切除术中持续术中神经监测（CIONM）引起的迷走神经损伤的模式、机制和预后，并概述预防策略。数据来源：前瞻性维护的甲状腺切除术数据库（2014-2024）、手术记录、麻醉图表、术中肌电图（EMG）数据和标准化术后喉镜检查。回顾方法：回顾性鉴定全甲状腺切除术后使用CIONM的所有VN损伤。VN损伤定义为新发同侧声带麻痹伴突然或明显的VN肌电图丧失，非喉返神经（RLN）损伤，近端刺激缺失和远端刺激保留。变量包括人口统计学、手术入路、器械类型、VN地形、损伤时间和机制、肌电图模式以及180天的恢复情况。发生率按每条有危险的神经计算。分析是描述性的。结果：1060例甲状腺切除术（2120例有危险神经）中，VN损伤9例（0.42%）。八个是暂时的，一个是永久的。大多数损伤（89%）发生在最初的颈动脉鞘剥离或探头应用时，特别是在VN后位或短而粗的颈部。较老的周向探头更常受累。所有病变均呈节段性，保留了RLN肌电图。未观察到全局VN损伤、宏观破裂、热损伤或术中血流动力学不稳定。肌电完全丧失预示着唯一的永久性瘫痪；部分振幅/潜伏期变化得到解决。早期识别、停止操作和及时的语音治疗有助于康复。结论：cionm相关性VN损伤发生率低（0.4%），多数病例在4个月左右恢复。与cionm相关的VN损伤通常与神经暴露有关，而不是与探针处理有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Head and Neck-Journal for the Sciences and Specialties of the Head and Neck 医学-耳鼻喉科学

CiteScore

7.00

自引率

6.90%

发文量

278

审稿时长

1.6 months

期刊介绍： Head & Neck is an international multidisciplinary publication of original contributions concerning the diagnosis and management of diseases of the head and neck. This area involves the overlapping interests and expertise of several surgical and medical specialties, including general surgery, neurosurgery, otolaryngology, plastic surgery, oral surgery, dermatology, ophthalmology, pathology, radiotherapy, medical oncology, and the corresponding basic sciences.