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Background <p>During thyroidectomy, patients are commonly positioned with neck extension using a shoulder roll. Excessive extension may impair arterial and venous outflow, compromise cerebral perfusion, and elevate intracranial pressure, potentially leading to postoperative cognitive impairment. This study investigated the effect of shoulder-roll-assisted neck extension on cognitive outcomes and on optic nerve sheath diameter (ONSD).</p> Methods <p>After tracheal intubation, patients were randomly assigned to either a shoulder roll group or a control group without a roll. The primary outcome was the Montreal Cognitive Assessment (MoCA) score at 6&#xa0;h postoperatively. Secondary outcomes included ONSD and the degree of neck extension.</p> Results <p>Postoperative MoCA scores were significantly lower in the shoulder roll group (20.56 ± 2.71) compared with the control group (23.57 ± 2.37; <i>P</i> &lt; 0.001). ONSD increased over time in both groups (<i>P</i> &lt; 0.001), but repeated-measures analysis showed no significant difference between groups (<i>P</i> = 0.333). Neck extension was greater in the shoulder roll group (126 ± 4.36°) than in the control group (116 ± 3.74°; <i>P</i> &lt; 0.001).</p> Conclusions <p>Shoulder roll positioning during thyroidectomy was associated with lower MoCA scores at 6&#xa0;h, indicating mild postoperative cognitive decline. Although greater neck extension was observed, ONSD values did not significantly differ between groups.</p> Trial registration <p>Muğla Sıtkı Koçman University Clinical Research Ethics Committee (approval number T-XII, June 17, 2019). Australian New Zealand Clinical Trials Registry (registration number: ACTRN12619001066178, date of registration: July 31, 2019).</p>

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Neck extension during thyroidectomy: effects on early postoperative cognitive function and optic nerve sheath diameter- a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月1日

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  • Başak Altıparmak,
  • Ahmet Pınarbaşı,
  • Melike Korkmaz Toker,
  • Ali İhsan Uysal,
  • Mustafa Turan

摘要

Background

During thyroidectomy, patients are commonly positioned with neck extension using a shoulder roll. Excessive extension may impair arterial and venous outflow, compromise cerebral perfusion, and elevate intracranial pressure, potentially leading to postoperative cognitive impairment. This study investigated the effect of shoulder-roll-assisted neck extension on cognitive outcomes and on optic nerve sheath diameter (ONSD).

Methods

After tracheal intubation, patients were randomly assigned to either a shoulder roll group or a control group without a roll. The primary outcome was the Montreal Cognitive Assessment (MoCA) score at 6 h postoperatively. Secondary outcomes included ONSD and the degree of neck extension.

Results

Postoperative MoCA scores were significantly lower in the shoulder roll group (20.56 ± 2.71) compared with the control group (23.57 ± 2.37; P < 0.001). ONSD increased over time in both groups (P < 0.001), but repeated-measures analysis showed no significant difference between groups (P = 0.333). Neck extension was greater in the shoulder roll group (126 ± 4.36°) than in the control group (116 ± 3.74°; P < 0.001).

Conclusions

Shoulder roll positioning during thyroidectomy was associated with lower MoCA scores at 6 h, indicating mild postoperative cognitive decline. Although greater neck extension was observed, ONSD values did not significantly differ between groups.

Trial registration

Muğla Sıtkı Koçman University Clinical Research Ethics Committee (approval number T-XII, June 17, 2019). Australian New Zealand Clinical Trials Registry (registration number: ACTRN12619001066178, date of registration: July 31, 2019).