Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery
Vagal nerve stimulation without dissecting the carotid sheath during intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery
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DOI：
10.1002/hed.23154
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发表时间：
2013-10-01
影响因子：
2.9
通讯作者：
Chiang, Feng-Yu
中科院分区：
文献类型：
--
作者：
Wu, Che-Wei;Dionigi, Gianlorenzo;Chiang, Feng-Yu
迷走神经刺激(VNS)是喉返神经(RLN)术中神经监测(IONM)的常规方法。然而，由于需要打开颈动脉鞘，许多外科医生被劝阻不要进行VNS。本研究的目的是探讨不剥离颈动脉鞘的VNS手术的可行性和可靠性。在IONM中，只需在颈动脉和颈静脉之间的间隙按压球头刺激器，即可实施不暴露神经的VNS。所有VNS信号均在手术开始后30min内成功获得，均显示出清晰可靠的喉肌电(EMG)反应，与传统的神经显露VNS方法相似。结论不剥离颈动脉鞘的VNS手术是可行的、可靠的，是IONM手术中一种简单、安全、方便的手术方法。(C)2012 Wiley期刊，Inc.Head Neck 35：1443-1447,2013
BackgroundVagal nerve stimulation (VNS) has been recommended as a routine procedure during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN). However, many surgeons have been discouraged from performing VNS because of the need for opening the carotid sheath. The purpose of this study was to investigate the feasibility and reliability of VNS without carotid sheath dissection.MethodsTwo hundred twenty patients with 376 nerves at risk were enrolled in this study. VNS without nerve exposure during IONM was applied by simply pressing a ball-tip stimulator on the space between the carotid artery and jugular vein.ResultsVNS without nerve exposure was feasible in all cases and did not result in any morbidity. All VNS signals were successfully obtained within 30 minutes of the start of the operation and all showed a clear and reliable laryngeal electromyography (EMG) response that was similar to that from the conventional method in which nerve exposure for VNS is applied.ConclusionsVNS without dissecting the carotid sheath is feasible and reliable, rendering it a simple, safe, and surgeon-friendly procedure during IONM. (c) 2012 Wiley Periodicals, Inc. Head Neck 35: 1443-1447, 2013