A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option
Background: The advantage of intraoperative neuromonitoring (IONM) has been widely accepted in thyroid/parathyroid surgery. However, there are discrepancies of amplitudes on recurrent laryngeal nerve (RLN) palsy and vocal cord paralysis (VCP) because of amplitude variations among individuals. Accord...
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Elsevier
2025-01-01
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| Series: | Surgery Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845024001453 |
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| author | Hiroshi Katoh, MD, FACS Riku Okamoto, MD Kanako Naito, MD Tomoya Mitsuma, MD Mariko Kikuchi, MD Takaaki Tokito, MD Takeshi Naitoh, MD, FACS Naoki Hiki, MD Yusuke Kumamoto, MD Takafumi Sangai, MD |
| author_facet | Hiroshi Katoh, MD, FACS Riku Okamoto, MD Kanako Naito, MD Tomoya Mitsuma, MD Mariko Kikuchi, MD Takaaki Tokito, MD Takeshi Naitoh, MD, FACS Naoki Hiki, MD Yusuke Kumamoto, MD Takafumi Sangai, MD |
| author_sort | Hiroshi Katoh, MD, FACS |
| collection | DOAJ |
| description | Background: The advantage of intraoperative neuromonitoring (IONM) has been widely accepted in thyroid/parathyroid surgery. However, there are discrepancies of amplitudes on recurrent laryngeal nerve (RLN) palsy and vocal cord paralysis (VCP) because of amplitude variations among individuals. Accordingly, the universal usefulness of quantitative amplitude value per se among patients were assessed. Study design: IONM using a 4-step method (Vagus nerve (V1)-RLN (R1)-R2-V2) was applied to 777 RLNs (510 patients). Forty-nine RLNs were excluded because of either loss of signal without preoperative VCP or combined RLN resection. The remaining 728 RLNs were evaluated. The optimal cut-offs of amplitudes or ratios of amplitude decrease on VCP were determined and evaluated. An independent recent cohort (177 RLNs) was analyzed for validation. Results: Quantitative amplitudes of V2 or R2, and V2/V1 or R2/R1 ratio predicted VCP. The V2 of 117–216 μV predicted VCP with high (>80 %) sensitivity and specificity. Interestingly, the AUC of ROC curve of V2 was the highest, and a cut-off 124 μV of V2 most excellently predicted VCP with the highest sensitivity, specificity, and both positive and negative predictive values. In dissociative analyses, a V2 cut-off 124 μV still excellently predicted VCP in all ranges of initial V1 ≥ 100 μV. In a validation cohort, the V2 of 126–205 μV (cut-off 197 μV) predicted VCP with both high (>80 %) sensitivity and specificity. Conclusions: A quantitative V2 amplitude can predict postoperative VCP among individuals as a simple and a second option, that may be especially useful in some circumstances with unavoidable insufficient initial exposure of vagus nerve. |
| format | Article |
| id | doaj-art-2007eceff4314f918314c0980298c904 |
| institution | Kabale University |
| issn | 2589-8450 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj-art-2007eceff4314f918314c0980298c9042025-01-31T05:12:17ZengElsevierSurgery Open Science2589-84502025-01-01235765A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second optionHiroshi Katoh, MD, FACS0Riku Okamoto, MD1Kanako Naito, MD2Tomoya Mitsuma, MD3Mariko Kikuchi, MD4Takaaki Tokito, MD5Takeshi Naitoh, MD, FACS6Naoki Hiki, MD7Yusuke Kumamoto, MD8Takafumi Sangai, MD9Department of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, Japan; Corresponding author at: Department of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.Department of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Lower Gastrointestinal Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Upper Gastrointestinal Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanDepartment of Breast and Thyroid Surgery, Kitasato University Hospital/Kitasato University School of Medicine, Kanagawa, JapanBackground: The advantage of intraoperative neuromonitoring (IONM) has been widely accepted in thyroid/parathyroid surgery. However, there are discrepancies of amplitudes on recurrent laryngeal nerve (RLN) palsy and vocal cord paralysis (VCP) because of amplitude variations among individuals. Accordingly, the universal usefulness of quantitative amplitude value per se among patients were assessed. Study design: IONM using a 4-step method (Vagus nerve (V1)-RLN (R1)-R2-V2) was applied to 777 RLNs (510 patients). Forty-nine RLNs were excluded because of either loss of signal without preoperative VCP or combined RLN resection. The remaining 728 RLNs were evaluated. The optimal cut-offs of amplitudes or ratios of amplitude decrease on VCP were determined and evaluated. An independent recent cohort (177 RLNs) was analyzed for validation. Results: Quantitative amplitudes of V2 or R2, and V2/V1 or R2/R1 ratio predicted VCP. The V2 of 117–216 μV predicted VCP with high (>80 %) sensitivity and specificity. Interestingly, the AUC of ROC curve of V2 was the highest, and a cut-off 124 μV of V2 most excellently predicted VCP with the highest sensitivity, specificity, and both positive and negative predictive values. In dissociative analyses, a V2 cut-off 124 μV still excellently predicted VCP in all ranges of initial V1 ≥ 100 μV. In a validation cohort, the V2 of 126–205 μV (cut-off 197 μV) predicted VCP with both high (>80 %) sensitivity and specificity. Conclusions: A quantitative V2 amplitude can predict postoperative VCP among individuals as a simple and a second option, that may be especially useful in some circumstances with unavoidable insufficient initial exposure of vagus nerve.http://www.sciencedirect.com/science/article/pii/S2589845024001453Intraoperative nerve monitoringVocal cord paralysisVagus nerveQuantitative amplitudeThyroid diseaseParathyroid disease |
| spellingShingle | Hiroshi Katoh, MD, FACS Riku Okamoto, MD Kanako Naito, MD Tomoya Mitsuma, MD Mariko Kikuchi, MD Takaaki Tokito, MD Takeshi Naitoh, MD, FACS Naoki Hiki, MD Yusuke Kumamoto, MD Takafumi Sangai, MD A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option Surgery Open Science Intraoperative nerve monitoring Vocal cord paralysis Vagus nerve Quantitative amplitude Thyroid disease Parathyroid disease |
| title | A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option |
| title_full | A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option |
| title_fullStr | A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option |
| title_full_unstemmed | A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option |
| title_short | A quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid/parathyroid surgery as a second option |
| title_sort | quantitative amplitude of vagus nerve obtained by intraoperative neuromonitoring predicts postoperative vocal cord paralysis among patients in thyroid parathyroid surgery as a second option |
| topic | Intraoperative nerve monitoring Vocal cord paralysis Vagus nerve Quantitative amplitude Thyroid disease Parathyroid disease |
| url | http://www.sciencedirect.com/science/article/pii/S2589845024001453 |
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