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Atlas of Intraoperative

Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery

Alexander L. Shifrin Alan D. Deutsch Gregory W. Randolph

Editors

123

Atlas of Intraoperative Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery

Alexander L. Shifrin • Alan D. Deutsch Gregory W. Randolph

Editors

Atlas of Intraoperative Cranial Nerve Monitoring in Thyroid and Head and Neck Surgery

Editors

Alexander L. Shifrin Surgical Director of Endocrinology Atlantic Health CentraState Medical Center Freehold, NJ, USA

Gregory W. Randolph Otolaryngology Head and Neck Surgery Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology Harvard Medical School Boston, MA, USA

Alan D. Deutsch Monmouth Ocean Neurology Neptune, NJ, USA

ISBN 978-3-031-24612-8 ISBN 978-3-031-24613-5 (eBook)

https://doi.org/10.1007/978-3-031-24613-5

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.

This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

The recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN), the vagus nerve, the spinal accessory nerve, the hypoglossal nerve, and the phrenic nerve can be at risk during thyroid, parathyroid, and modied radical neck dissection surgery.

The most common injury during thyroidectomy, injury to the RLN, can signicantly impact the quality of life, altering the ability to speak, swallow, and/or breathe and may risk tracheotomy. Serious consequences also will result from injuries to the vagus, the hypoglossal, the spinal accessory, and the phrenic nerves.

Successful management and preservation of these nerves during thyroid, parathyroid, and radical modied neck dissection surgery requires a thorough understanding of the anatomy and function of nerves. Intraoperative neurophysiologic monitoring (IONM) has gained increased acceptance since its early description over 50years ago as an adjunctive technique for nerves preservation, offering a dynamic functional assessment of the nerves’ functions. Utilization of IONM enables the surgeon to interrogate nerve anatomy and function with immediate quantitative feedback, thereby augmenting surgical training. Importantly, surgical skills and sound anatomic knowledge remain prerequisites and are not supplanted by IONM use. Application of IONM in head and neck surgery, including indications, techniques, and pitfalls, is required for residents and fellows in surgery, specically endocrine surgery and otolaryngology- head and neck surgery programs. For those receiving fellowship training under the supervision of the AHNS or the AAES, thorough understanding and ability to perform IONM of the RLN is required. As exposure to IONM during training has been shown to be associated with higher utilization by surgeons upon entering practice independently, continued increase in utilization is expected. Nonetheless, there remains inconsistency globally in training and application of IONM.

This Atlas is designed to help all endocrine surgeons, otolaryngology surgeons, and head and neck surgeons to learn the IONM technique, and to interpret the result of the nerves’ stimulations, in order to prevent devastating injuries. This Atlas consists of several chapters that are specically illustrating different nerves’ responses and include the RLN, the EBSLN, the vagus nerve, the hypoglossal nerve, the spinal accessory nerve, and the phrenic nerve.

Freehold, NJ, USA AlexanderL.Shifrin Neptune, NJ, USA AlanD.Deutsch Boston, MA, USA GregoryW.Randolph

Acknowledgments

The creation of this atlas was dependent on a team effort, which was possible only with the support and enthusiasm of the many individuals who contributed to this book: Hanna Kratochvil, Jeremy Goldfarb, Christopher Blake Sullivan, Erivelto Volpi, Joseph Scharpf, Amanda Silver Karcioglu, Marika D.Russell, Amr H.Abdelhamid Ahmed, Marcin Barczynski, Claudio R. Cernea, Joseph DiAngelo, Pedro Garcia, Thomas Lopazanski, Rick Schneider, Che-Wei Wu, Özer Makay, Gianlorenzo Donigi, and Amr H. Abdelhamid Ahmed who provided an additional support to numerous chapters in this Atlas. We thank our colleagues who trusted us and dedicated their time and effort to make it happen, without whom this Atlas would have never come to life!

Special thanks to Executive Editors Richard Hruska and Kristopher Spring, who believed in us, and Senior Editor Lee Klein of Springer for his hard work and dedication.

Finally, I would like to thank the entire staff at Springer, who were very supportive from the rst idea of this atlas and maintained their enthusiasm throughout the project. Finally we wish to thank our patients with whom we learn the subtleties of surgical care of the neck base and their families who selessly indulge us in this study.

vii

Contents

1 Anatomy and Function of Cranial and Neck Nerves . . . . . . . . . . . . . . . . . . . . . . . . . 1

Brittany Al-Atrache and Alexander L. Shifrin

2 Electrophysiological Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Lawrence Mitelberg and Alexander L. Shifrin

3 Intraoperative Neurophysiologic Monitoring: A Neurologic Perspective . . . . . . . .13

Alan D. Deutsch

4 Intraoperative Neurophysiological Monitoring Anesthesia Perspective . . . . . . . . . 15

Hanna Kratochvil and Jeremy Goldfarb

5 Intraoperative Neurophysiological Monitoring Surgical Perspective . . . . . . . . . . . 19

Christopher Blake Sullivan, Erivelto Volpi, and Joseph Scharpf

6 Electrophysiologic RLN and Vagal Monitoring During Thyroid

and Parathyroid Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Amanda Silver Karcioglu, Marika D. Russell, Amr H. Abdelhamid Ahmed, and Gregory W. Randolph

7 External Branch of the Superior Laryngeal Nerve (EBSLN) Monitoring

During Thyroid and Parathyroid Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Marcin Barczyński and Claudio R. Cernea

8 Intraoperative Neurophysiologic Monitoring for the Recurrent

Laryngeal Nerve: Case Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47