Intraoperative Cranial Nerve Monitoring in Otolaryngology-Head and Neck Surgery

Preface
Contents
Contributors
Part I: Nerve Monitoring Principles
	1: Historical Perspective on Nerve Monitoring During Head and Neck Surgery
		The Cranial Nerves
		The Birth of Electrophysiology
		The Discovery of the Nerve Action Potential: A Triumph of Technology
		Electroencephalography (EEG), Peripheral Nerve Stimulation, Electromyography (EMG), and the Birth of Neuromonitoring
		The Rise of Intraoperative Neuromonitoring
		Intraoperative Facial Nerve Monitoring
		Intraoperative Recurrent Laryngeal Nerve Monitoring
		A Look into the Future
		Conclusion
		References
	2: Basic and Advanced Electrophysiology, Setup, and Anesthesia
		Introduction
		Electrophysiology
		Setup
		Risk of Electrical Interference
		Patient Positioning
		Monitor Assessment
		Anesthesia
		Conclusions
		References
	3: Anesthetic Considerations and Setup for Cranial Nerve Monitoring
		Introduction
		Anesthetic Considerations
			Neuromuscular Blockade and IONM
			Pediatric Anesthetic Considerations for IONM
		Intraoperative Nerve Monitoring Equipment Setup
			Brief Overview of Nerve Monitoring Equipment and Systems
			Recording Side Setup
			Monitoring Side Setup: Nerve-Specific IONM Electrode Placement
				Facial Nerve (CN VII) Monitoring
				Glossopharyngeal Nerve (CN IX) Monitoring
				Vagus Nerve (CN X) Monitoring
				Spinal Accessory Nerve (CN XI)
				Hypoglossal Nerve (CN XII)
				Review of Brachial Plexus and Spinal Monitoring
		Conclusion
		References
	4: Neural Injury Mechanisms
		Basic Anatomy and Physiology of Peripheral Nerves
		Classification of Injury
			Seddon Classification
			Sunderland Classification
		Mechanisms of Neural Injury
			Compression
			Ischemia/Idiopathic
			Ligation
			Thermal
			Traction
			Transection
		Risk of Nerve Injury
		References
	5: Neuromonitoring Usage Patterns and Education
		Usage Patterns
		Education
		Conclusion
		References
Part II: Vagus/Recurrent Laryngeal Nerve Monitoring
	6: Rationale and Indications for Vagus/Recurrent Laryngeal Nerve Monitoring
		Introduction
		Anatomy
			Vagal Nerve and Carotid Sheath Anatomy
			RLN Surgical Anatomic Trajectory in the Neck Base
			Clinically Important RLN Features
		Rationale of Vagus and Recurrent Laryngeal Nerve Monitoring
		Indications and Benefits of VN/RLN Monitoring
		Basic Standard VN and RLN Monitoring Procedures
		Loss of Signal: Definition and Classifications
		Clinically Significant Monitoring Applications
		Guidelines and Current Standards
		Conclusion
		References
	7: Methods of Recurrent Laryngeal Nerve Monitoring
		History of Nerve Monitoring
		Early Nerve Monitoring Technology
		Intermittent Electromyographic-Based Intraoperative Nerve Monitoring
			Anesthesia and Intubation
			EMG Waveform Parameters
		Continuous Intraoperative Nerve Monitoring
		Minimally Invasive Video-Assisted Thyroidectomy/Parathyroidectomy and Remote Access Robotic Thyroidectomy
		Does Use of IONM Decrease Rate of Nerve Injury?
		Conclusion
		References
	8: Monitoring of the Superior Laryngeal Nerve
		Introduction
			Surgical Anatomy
			How to Avoid Injury to the EBSLN During Thyroidectomy
			How to Diagnose the EBSLN Paralysis?
		Intraoperative Monitoring of the EBSLN
			Relevance of EBSLN Intraoperative Monitoring
			Does EBSLN Intraoperative Monitoring Reduce the Frequency of Nerve Injury?
			Frequency of Use of EBSLN Intraoperative Nerve Monitoring
			Normative Features of EBSLN Intraoperative Monitoring
		Final Messages
		References
	9: Intraoperative Cranial Nerve Monitoring in Otolaryngology – Head and Neck Surgery
		Introduction
		Rationale for Use
		Operating Instructions and Standardized Approach
			Safety
		Intraoperative Damage Control: Impending Nerve Injury and Intraoperative Recovery of EMG Signal
			Impending Nerve Injury and Artificial Electromyographic Tracing
			Intraoperative Recovery of EMG Signal
		Change in Surgical Strategy: Staged Thyroidectomy
		Superiority of Continuous over Intermittent Intraoperative Nerve Monitoring
		Future Perspectives
		References
	10: Emerging Trends for Vagus/Recurrent Laryngeal Nerve Monitoring
		Introduction
		Intermittent Nerve Monitoring Technologies
		Continuous Nerve Monitoring Technologies
		Controversies
		Conclusion
		References
	11: Troubleshooting System Integrity
		Introduction
		Mechanisms of RLN Injury
		Trends in Nerve Monitoring for Thyroid Surgery
		Intraoperative Troubleshooting of the Nerve Monitor
		Conclusion
		References
	12: Loss of Neural Signal in Thyroid and Parathyroid Surgery
		Introduction
		Preoperative Discussion
		Technical Considerations of Nerve Monitoring
		Loss of Signal: Intraoperative Troubleshooting
		Loss of Signal: Management Strategies
		Confirmed Laryngeal Dysfunction: Management Strategies
		Confirmed Laryngeal Dysfunction: Impact on Discharge
		Superior Laryngeal Nerve Injury
		Conclusions
		References
	13: Recurrent Laryngeal Nerve Monitoring and Decision-Making in Advanced Thyroid Cancer
		Advanced Thyroid Cancer
		Preoperative Recurrent Laryngeal Nerve Evaluation
		Preoperative Planning
		Intraoperative Recurrent Laryngeal Nerve Monitoring
		Intraoperative Decision-Making with Nerve Monitoring
		Conclusion
		References
	14: Nerve Monitoring in Remote Access Thyroid Surgery
		Introduction
		Intraoperative Nerve Monitoring
		RLN Monitoring in Remote Access Thyroid and Parathyroid Surgery
		Gasless Trans-Axillary Thyroidectomy and the Brachial Plexus
		Pathophysiology of Nerve Injury
		SSEPs: Basic Principles
		SSEP Electrodes
		Utility of Nerve Monitoring
		Conclusion
		References
	15: Nerve Monitoring During Parathyroid Surgery
		Introduction
		Neck Exploration
		Nerve Monitoring Techniques
		Neuromonitoring Applications
		Intraoperative Recurrent Laryngeal Nerve Injury
		Summary
		References
Part III: Facial Nerve, Glossopharyngeal Nerve, Hypoglossal Nerve, Brachial Plexus and Spine Monitoring
	16: Facial Nerve Monitoring: Extratemporal Facial Nerve
		Introduction
		Monitoring Methods and Systems
		Technique
		Interpretation
		Benefits
		Limitations and Potential Complications
		Conclusions
		References
	17: Spinal Accessory Nerve Monitoring in Head and Neck Surgery
		Introduction
		Anatomy
		Postoperative Shoulder Syndrome
		Surgeries that Risk the SAN
			Neck Dissection
			Surgery in the Posterior Triangle
			Lateral Skull Base Surgery
		SAN Monitoring
		Conclusion/Summary
		References
	18: Glossopharyngeal (CN IX) and Hypoglossal (CN XII) Nerve Stimulation and Monitoring
		Glossopharyngeal Nerve (CN IX)
		Hypoglossal Nerve (CN XII)
			Overview
			Hypoglossal Nerve Branch Identification with Stimulation and Monitoring: Technical Aspects
		Summary
		References
	19: Brachial Plexus and Spinal Nerve Monitoring
		Introduction
		Intraoperative Neuromonitoring (IOM) in Spine Surgery
			Stagnara Wake-Up Test
			Somatosensory Evoked Potentials (SSEP)
			Motor Evoked Potentials (MEPs)
			Spontaneous Electromyography
			Triggered Electromyography
		Intraoperative Neuromonitoring (IOM) in Brachial Plexus Surgery
			Somatosensory Evoked Potentials (SSEP) and Motor Evoked Potentials (MEP)
			Triggered Electromyography (tEMG)
			Nerve Action Potentials (NAPs)
		Intraoperative Neuromonitoring in Practice
			Multimodal Intraoperative Monitoring (MIOM)
			Team-Based Approach for IOM
			Practical Considerations of IOM
		Conclusion
		References
Part IV: Miscellaneous Nerve Monitoring Considerations
	20: Documentation and Reimbursement
		Introduction
		IONM as a Distinct Procedure
		Role of the Operating Surgeon
		Reimbursement for IONM
		Documentation for IONM
		Conclusions
		References
	21: Ethical Considerations for Nerve Monitoring
		Introduction
		Informed Consent
		Ethics and Neuromonitoring
		Informed Consent and Neuromonitoring
		Additional Ethical Considerations
		Medical-Legal Issues in Nerve Monitoring
		Conclusions
		References
	22: Nerve Monitoring and Medical Malpractice
		Introduction
		Medical Malpractice
		Recurrent Laryngeal Nerve Injury
		Intraoperative Neuromonitoring in Thyroid Surgery
		Medical Malpractice in Thyroid Surgery
		Preventing Medical Malpractice
		Conclusion
		References
Index