Gallucci Pierpaolo, Procopio Priscilla Francesca, Pennestrì Francesco, Marincola Giuseppe, D'Alatri Lucia, Martullo Annamaria, De Crea Carmela, Raffaelli Marco
UOC Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.Go Agostino Gemelli 8, 00168, Rome, Italy.
Centro Di Ricerca in Chirurgia Delle Ghiandole Endocrine E Dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
Updates Surg. 2025 Aug 20. doi: 10.1007/s13304-025-02373-0.
Loss of signal (LOS) at intraoperative nerve monitoring (IONM) is defined as an >100 mV amplitude decrease and a >10% latency reduction and represents a predictor of postoperative impaired vocal cord motility (VCM). We aimed to evaluate if an intraoperative signal recovery (ISR) after LOS may predict a positive outcome of VCM. Among 5884 consecutive intermittent IONM-guided thyroidectomies (April 2021- March 2025) all the patients in whom a LOS was observed were evaluated. Topic and intravenous corticosteroids were administered to all of them. Eventual recovery was evaluated after 20 minutes. Patients with an ISR less than 50% compared to the baseline were included. The rate of vagal signal (VS) ISR was defined as a percent from the minimum value: VS-recovery-VS-minimal/VS-predissection-VS-minumum. ISR was correlated to VCM (ROC curve analysis). Among 169 patients with LOS, 65 (38.5%) showed ISR, with 48 (73.8%) of them exhibiting normal VCM on postoperative day 1 (POD-1). The remaining 17 patients with impaired VCM on POD-1 recovered normal VCM on POD-15 (7-10.8%) or POD-30 (10-15.4%). The AUC for impaired VCM at POD-1 was 0.938 (95% CI: 0.849-0.983, p <0.0001) and the ISR cut-off was 13%, with a 94.1% sensitivity and a 89.6% specificity. All patients with ISR >31% showed normal VCM. All patients with ISR <13% exhibited impaired motility at POD-15 but recovered at POD-30. ISR can predict full recovery of VCM. ISR >31% is associated with normal postoperative VCM and staged thyroidectomy could be avoided in this subgroup of patients with LOS.
术中神经监测（IONM）时信号丢失（LOS）定义为振幅下降>100 mV且潜伏期缩短>10%，它是术后声带运动障碍（VCM）的一个预测指标。我们旨在评估LOS后术中信号恢复（ISR）是否可预测VCM的良好预后。在连续5884例IONM引导下的间歇性甲状腺切除术（2021年4月至2025年3月）中，对所有观察到LOS的患者进行评估。对所有患者给予局部和静脉注射皮质类固醇。20分钟后评估最终恢复情况。纳入ISR低于基线值50%的患者。迷走神经信号（VS）ISR率定义为相对于最小值的百分比：VS恢复值-VS最小值/VS解剖前值-VS最小值。ISR与VCM相关（ROC曲线分析）。在169例出现LOS的患者中，65例（38.5%）出现ISR，其中48例（73.8%）在术后第1天（POD-1）声带运动正常。其余17例POD-1时声带运动障碍的患者在POD-15（7-10.8%）或POD-30（10-15.4%）时恢复正常声带运动。POD-1时声带运动障碍的AUC为0.938（95%CI：0.849-0.983，p<0.0001），ISR临界值为13%，敏感性为94.1%，特异性为89.6%。所有ISR>31%的患者声带运动均正常。所有ISR<13%的患者在POD-15时运动障碍，但在POD-30时恢复。ISR可预测VCM的完全恢复。ISR>31%与术后声带运动正常相关，对于这一出现LOS的亚组患者可避免分期甲状腺切除术。
