title: Intraoperative neural monitoring in thyroid cancer surgery.
abstract: BACKGROUND
  Intraoperative neural monitoring (IONM) has increasingly garnered the attention of the surgeons performing thyroid and parathyroid surgery around the world. Current studies suggest a majority of general and head and neck surgeons utilize neural monitoring in their thyroid surgical case load in both the US and Germany.
  
  
  OBJECTIVE
  We aim to present an up-to-date review of the application of IONM specifically focusing on its utility in thyroid cancer surgery. Neural monitoring is discussed particularly as it relates to neural prognosis, the issues of staged thyroid surgery for thyroid cancer, and new horizons in the monitoring of the superior laryngeal nerve (SLN) and prevention of neural injury through continuous vagal neural monitoring.
  
  
  CONCLUSIONS
  IONM, as it relates to thyroid surgery, has obtained a widespread acceptance as an adjunct to the gold standard of visual nerve identification. The value of IONM in prognosticating neural function and in intraoperative decision making regarding proceeding to bilateral surgery is also well-known. Initial data on recent extensions of IONM in the form of SLN monitoring and continuous vagal nerve monitoring are promising. Continuous vagal nerve monitoring expands the utility of IONM by providing real-time electrophysiological information, allowing surgeons to take a corrective action in impending neural injury.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Division of Thyroid and Parathyroid Surgery, Harvard Medical School, 243, Charles St., Boston, MA, 02114, USA, gregory_randolph@meei.harvard.edu.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
mesh_terms: D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology* / Q000517:prevention & control*; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D061224:Laryngeal Nerve Injuries / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control*; D007823:Laryngeal Nerves / Q000473:pathology / Q000503:physiopathology*; D009361:Neoplasm Invasiveness / Q000473:pathology; D011379:Prognosis; D012086:Reoperation; D012815:Signal Processing, Computer-Assisted; D013964:Thyroid Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014630:Vagus Nerve / Q000503:physiopathology; D014826:Vocal Cord Paralysis / Q000503:physiopathology* / Q000517:prevention & control*