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수술 중 신경모니터링시 신호 소실의 해석과 단계적 갑상선 절제술
이동원(Dong Won Lee) 대한신경모니터링학회 2022 Journal of Neuromonitoring & Neurophysiology Vol.2 No.1
Intraoperative neuromonitoring (IONM) has been introduced as a promising technology that can help minimize recurrent nerve injury. The IONM can identify anatomical variations and unusual nerve routes, which are associated with increased risks of injury if they are not identified. The IONM helps predict postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it allows a surgeon to stage bilateral surgery to avoid bilateral vocal cord paralysis and tracheotomy. This review summarizes definition of electrophysiologic adverse signal including loss of signal, and their incorporation into the staged bilateral thyroidectomy process.
Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy
Hoon Yub Kim,Hui Sun,Young Jun Chai,Ralph Tufano,Henning Dralle,Giuseppe Navarra,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3
With an increased use of intraoperative neural monitoring (IONM), an adaptation of the resection strategy appears to be necessary in case of an intraoperative loss of signal (LOS) of the first operated side with total thyroidectomy planned. The contralateral side resection with intact recurrent laryngeal nerve (RLN) function from the surgical point of view, basically has 3 options: 1) no contralateral resection in bilateral goiter, Graves disease, or low risk thyroid carcinoma (differentiated and medullary thyroid carcinomas) with the aim of 2-stage completion surgery after recovery of nerve function; 2) contralateral subtotal resection ventrally of the RLN plane in benign goiter with a safety distance to the nerve with the aim of avoiding further surgery; and 3) total thyroidectomy as planned for advanced thyroid carcinomas (including undifferentiated thyroid carcinomas) with the aim of immediate postoperative radioiodotherapy. The following document provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the strategy for planned total thyroidectomy and loss of the neuromonitoring signal on the first thyroid lobe.