{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:31:44Z","timestamp":1780317104808,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2015,12,17]],"date-time":"2015-12-17T00:00:00Z","timestamp":1450310400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2015,12,17]],"date-time":"2015-12-17T00:00:00Z","timestamp":1450310400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Continuous vagal intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve (RLN) may reduce the risk of RLN lesions during high\u2010risk endocrine neck surgery such as operation for large goiter potentially requiring transsternal surgery, advanced thyroid cancer, and recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010five consecutive patients (41 female, median age 61 years, 87\u00a0nerves at risk) underwent high\u2010risk endocrine neck surgery. CIONM was performed using the commercially available NIM\u2010Response 3.0\u00a0nerve monitoring system with automatic periodic stimulation (APS) and matching endotracheal tube electrodes (Medtronic Inc.). All CIONM events (decreased amplitude\/increased latency) were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>APS malfunction occurred on three sides (3 %). A total of 138 CIONM events were registered on 61 sides. Of 138, 47 (34 %) events were assessed as imminent (13 events) or potentially imminent (34 events) lesions, whereas 91 (66 %) were classified as artifacts. Loss of signal was observed in seven patients. Actions to restore the CIONM baseline were undertaken in 58\/138 (42 %) events with a median 60 s required per action. Four RLN palsies (3 transient, 1 permanent) occurred: one in case of CIONM malfunction, two sudden without any significant previous CIONM event, and one without any CIONM event. The APS vagus electrode led to temporary damage to the vagus nerve in two patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CIONM may prevent RLN palsies by timely recognition of imminent nerve lesions. In high\u2010risk endocrine neck surgery, CIONM may, however, be limited in its utility by system malfunction, direct harm to the vagus nerve, and particularly, inability to indicate RLN lesions ahead in time.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-015-3368-y","type":"journal-article","created":{"date-parts":[[2015,12,17]],"date-time":"2015-12-17T19:03:33Z","timestamp":1450379013000},"page":"672-680","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Impact of EMG Changes in Continuous Vagal Nerve Monitoring in High\u2010Risk Endocrine Neck Surgery"],"prefix":"10.1002","volume":"40","author":[{"given":"Katrin","family":"Brauckhoff","sequence":"first","affiliation":[{"name":"Department of Surgery Haukeland University Hospital Jonas Lies vei 65 5021 Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate","family":"Vik","sequence":"additional","affiliation":[{"name":"Department of Surgery Haukeland University Hospital Jonas Lies vei 65 5021 Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorentz","family":"Sandvik","sequence":"additional","affiliation":[{"name":"Department of ENT Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John\u2010Helge","family":"Heimdal","sequence":"additional","affiliation":[{"name":"Department of ENT Haukeland University Hospital Bergen Norway"},{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turid","family":"Aas","sequence":"additional","affiliation":[{"name":"Department of Surgery Haukeland University Hospital Jonas Lies vei 65 5021 Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Biermann","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Bergen Bergen Norway"},{"name":"Department of Radiology Haukeland University Hospital Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Brauckhoff","sequence":"additional","affiliation":[{"name":"Department of Surgery Haukeland University Hospital Jonas Lies vei 65 5021 Bergen Norway"},{"name":"Department of Clinical Science University of Bergen Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,12,17]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010008\u20109483\u20102"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.21119"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.8831"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6417"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010013\u20102260\u2010x"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2008.02.006"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24550"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010012\u20101853\u20100"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23187"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010009\u20100316\u20108"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010005\u20100355\u20108"},{"key":"e_1_2_6_13_2","doi-asserted-by":"crossref","unstructured":"BiermannM Kr\u00e5kenesJ BrauckhoffKet al. 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