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<p>Loss of signal (LOS) at intraoperative nerve monitoring (IONM) is defined as an&#xa0;&gt;100 mV amplitude decrease  and a &gt;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&#xa0;minutes. Patients with&#xa0; an&#xa0;ISR&#xa0;less than&#xa0; 50% compared to the&#xa0;baseline were included. The rate of vagal signal (VS)&#xa0;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&#xa0;exhibiting normal VCM on postoperative day 1 (POD-1). The remaining 17 patients with impaired VCM&#xa0;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 &lt;0.0001) and the ISR cut-off was 13%, with a 94.1% sensitivity and a 89.6% specificity. All patients with ISR &gt;31% showed normal VCM. All patients with ISR &lt;13% exhibited impaired motility at POD-15 but recovered at POD-30. ISR can predict full recovery of VCM. ISR &gt;31% is associated with normal postoperative VCM and staged thyroidectomy could be avoided in this subgroup of patients with LOS.</p>

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Partial intraoperative signal recovery is associated with normal postoperative vocal cord motility in patients with intraoperative loss of signal

  • 期刊论文

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  • 发表日期：

    2025年8月20日

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  • Pierpaolo Gallucci,
  • Priscilla Francesca Procopio,
  • Francesco Pennestrì,
  • Giuseppe Marincola,
  • Lucia D’Alatri,
  • Annamaria Martullo,
  • Carmela De Crea,
  • Marco Raffaelli

摘要

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.