Department of Surgery, Anesthesia and Interventional Medicine, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France.
Department of Radiology, Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France.
Eur Radiol. 2021 Jun;31(6):4063-4070. doi: 10.1007/s00330-020-07472-7. Epub 2020 Nov 25.
Localization of the vagus nerve is required during intraoperative neuromonitoring (IONM) for thyroid surgery in order to electromyographically verify the functional integrity of inferior laryngeal nerve and aim to reduce the risk of postoperative vocal fold paralysis. Classically, the vagus nerve courses within the carotid sheath between the common carotid artery and internal jugular vein, but anatomic variations have been described. Our aim was to compare preoperative ultrasound (US) and intraoperative localization of vagus nerve and to document anatomic variations.
Retrospective study of patients undergoing thyroidectomy. The vagus nerve was identified 2 cm below the inferior border of the cricoid cartilage, on US performed 6 weeks prior to surgery; then, vagus nerve was identified surgically.
For 82 patients, on preoperative US, the right vagus nerve was in between, superficial, or deep to the vessels in 94%, 2.4%, and 3.6%, and on the left in 72%, 24.4%, and 3.6%. Intraoperatively, the right vagus was in between, superficial, or deep in 90%, 4%, and 6%, and on the left in 67%, 27%, and 6%. US correlated with surgery on the right in 79/82 (96%) and on the left in 78/82 (95%).
To our knowledge, this is the first study directly comparing US and intraoperative findings. The US and surgical findings were identical in 95% on the left and 96% on the right The vagus nerve was superficial in 27% of cases on the left and 4% on the right. Identifying this anatomic variation preoperatively may facilitate IONM.
• Localization of the vagus nerve is necessary during thyroid surgery when using neuromonitoring for electromyographic testing of the inferior laryngeal nerve to reduce the risk of postoperative vocal fold paralysis. • The vagus nerve in the neck can be routinely visualized using ultrasound, and is generally in between the common carotid artery and the internal jugular vein. Its location on ultrasound corresponds very closely to that observed in vivo during surgery (95%). • At the level of the thyroid lobe, there is an anatomic variant with the vagus nerve superficial to the common carotid artery which is seen more often on the left than on the right.
在甲状腺手术的术中神经监测（IONM）期间需要对迷走神经进行定位，以便肌电图验证喉返神经的功能完整性，并旨在降低术后声带麻痹的风险。经典地，迷走神经在颈总动脉和颈内静脉之间的颈动脉鞘内走行，但是已经描述了解剖变异。我们的目的是比较术前超声（US）和术中迷走神经定位，并记录解剖变异。
回顾性研究接受甲状腺切除术的患者。在手术前 6 周进行的超声检查中，在环状软骨下缘下方 2 厘米处识别迷走神经；然后，在手术中识别迷走神经。
对于 82 例患者，在术前 US 上，右侧迷走神经在 94%、2.4%和 3.6%的血管之间、浅层或深层，左侧在 72%、24.4%和 3.6%。术中，右侧迷走神经在 90%、4%和 6%之间，左侧在 67%、27%和 6%之间。右侧的 82/82（96%）和左侧的 82/82（95%）的 US 与手术相关。
据我们所知，这是第一项直接比较 US 和术中发现的研究。左侧的 95%和右侧的 96%的 US 和手术结果完全一致。左侧的 27%和右侧的 4%的迷走神经浅层。术前识别这种解剖变异可能有助于 IONM。
在甲状腺手术中，当使用神经监测对喉返神经进行肌电图测试以降低术后声带麻痹的风险时，需要对迷走神经进行定位。
颈部的迷走神经可以使用超声常规显示，通常位于颈总动脉和颈内静脉之间。它在超声上的位置与术中活体观察非常吻合（95%）。
在甲状腺叶水平，存在一种迷走神经位于颈总动脉浅层的解剖变异，这种变异在左侧比右侧更常见。
