title: Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.
abstract: Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.
authors.affiliation: Department of Otology and Laryngology, Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA. Gregory_Randolph@meei.harvard.edu
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Hisham
authors.initials: H
authors.lastname: Abdullah
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczynski
authors.forename: Rocco
authors.initials: R
authors.lastname: Bellantone
authors.forename: Michael
authors.initials: M
authors.lastname: Brauckhoff
authors.forename: Bruno
authors.initials: B
authors.lastname: Carnaille
authors.forename: Sergii
authors.initials: S
authors.lastname: Cherenko
authors.forename: Fen-Yu
authors.initials: FY
authors.lastname: Chiang
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.forename: Camille
authors.initials: C
authors.lastname: Finck
authors.forename: Dana
authors.initials: D
authors.lastname: Hartl
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.forename: Kerstin
authors.initials: K
authors.lastname: Lorenz
authors.forename: Paolo
authors.initials: P
authors.lastname: Miccolli
authors.forename: Radu
authors.initials: R
authors.lastname: Mihai
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
authors.forename: Lisa
authors.initials: L
authors.lastname: Orloff
authors.forename: Nancy
authors.initials: N
authors.lastname: Perrier
authors.forename: Manuel Duran
authors.initials: MD
authors.lastname: Poveda
authors.forename: Anatoly
authors.initials: A
authors.lastname: Romanchishen
authors.forename: Jonathan
authors.initials: J
authors.lastname: Serpell
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitges-Serra
authors.forename: Tod
authors.initials: T
authors.lastname: Sloan
authors.forename: Sam
authors.initials: S
authors.lastname: Van Slycke
authors.forename: Samuel
authors.initials: S
authors.lastname: Snyder
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takami
authors.forename: Erivelto
authors.initials: E
authors.lastname: Volpi
authors.forename: Gayle
authors.initials: G
authors.lastname: Woodson
mesh_terms: D004576:Electromyography / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D038622:Internationality; D007431:Intraoperative Complications / Q000517:prevention & control; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards; D012009:Recurrent Laryngeal Nerve / Q000601:surgery; D061226:Recurrent Laryngeal Nerve Injuries; D012015:Reference Standards; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000517:prevention & control*