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At present, intraoperative neuromonitorization (IONM) with surface electrode-based endotracheal tube (ETT) is a standard method in thyroidectomy and can be performed either intermittently IONM (I-IONM) or continuously IONM (C-IONM). Despite the valuable contribution of I-IONM to the thyroidectomy, it still has limitations regarding the recording electrodes and stimulation probe. New approaches for overcoming the limitations of I-IONM and developing the method are taking attention. Most of the technical issues of IONM with surface electrode-based ETT are related with inadequate contact of electrodes to the vocal cords. Nowadays, efficiency of various recording electrodes is under investigation. Recording electrodes such as needle electrodes applied to thyroarytenoid or posterior cricoarytenoid muscle (PCA), surface electrodes applied to the PCA, and needle or adhesive electrodes applied to the tracheal cartilage or skin, can make safe recordings similar to the ETT electrodes. Despite their invasiveness, needle electrodes record higher electromyography (EMG) amplitudes than tube electrodes do. Adhesive surface electrodes make safe EMG recordings, although amplitudes of these electrodes are usually lower than those of the tube electrodes. These different types of electrodes are less affected by tracheal manipulations and amplitude changes are lower compared to the tube electrodes. During C-IONM, an additional stimulation probe is applied to the vagus nerve after dissecting the nerve circumferentially. Recently, without applying a probe, a new continuous monitorization method called laryngeal adductor reflex CIONM (LAR-CIONM) using sensorial, central, and motor components of LAR arch which is an automatic, primitive brainstem reflex protecting the tracheoesophageal tree from foreign body aspiration, has been implemented. Afferent track of LAR communicates laryngeal mucosa to the brainstem by internal branch of the superior laryngeal nerve and efferent track reaches larynx through recurrent laryngeal nerve. Total outcome of LAR activation is the closure of laryngeal entry by bilateral vocal cord adduction. In LAR-CIONM, a stimulus is given by an electrode from one side of surface electrode-based ETT and amplitude response of the LAR at the vocal cord is followed on the operation side. Recently, it has been reported that real-time EMG response can be obtained with stimulation probe cables applied to dissectors or energy devices during the dissection through I-IONM.
Currently, thyroidectomide is a standard method of intraoperative nerve monitoring (IONM) with the surface electrotic endotrakeal tube and can be applied in the form of interval (I-IONM) or continuous IONM (C-IONM). Despite I-IONM’s valuable contribution to thyroidectomy, there are some limitations in the recording electrots or warning samples. New approaches to overcome the limits of IONM and to develop the method are attracted. The majority of technical problems in IONM with the surface electro endotrakeal pipe are related to the failure of pipe electrots to properly contact the vocal cord. Today, the effectiveness of different recording electrots is being investigated. These recording electrots are of different types, such as thyroaritenoid or posterior krikoaritenoid box applied injection electrots, posterior krikoaritenoid muscle surface electrots, injection or adhesive surface electrots applied in the trakeal cartilage and adhesive or injection electrots applied on the skin, and they can also make safe EMG recording such as endotrakeal tube electrots. Although the igne electrots are invasive, they record higher EMG amplitude than the pipe electrots. Adhesive surface electrots and amplitude values are usually lower than tube electrots while reliable EMG recording can be done. These different types of electrots are less affected than traceal manipulation compared to tube electrots, and the amplitude changes are less. In C-IONM, an additional warning sample is applied to the vagus by disqueing the vagus circle. Recently, the continuous LAR-CIONM method, a continuous monitoring method of the laringeal adductor reflex (LAR), which is an unwanted, primitive brain deviation reflection that protects the trakeabronchial tree from the aspiration from the application of vagusa prob, has been clinically implemented using sensory, central and motor components. The afferent path of LAR reaches the laryngeal membrane to the brain with the internal branch of the superior laringeal nerve, and the eferent path reaches the laryngeal through the RLN. The total result of LAR activation is the closure of the laringeal entrance with bilateral vocal cord adduction. In LAR-CIONM, an alert from the electroth on one side of the surface electroth endotrakeal pipe is followed by the voice cord amplitude response on the operating side of LAR. Recently, it has been
Alan : Sağlık Bilimleri
Dergi Türü : Ulusal
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