{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T01:46:10Z","timestamp":1778291170282,"version":"3.51.4"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Projekt DEAL"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>This study aimed to establish an in-vitro alternative to existing in-vivo systems to analyze nerve dysfunction using continuous neuromonitoring (C-IONM).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Three hundred sixty-three recurrent laryngeal nerves (RLN) (N<jats:sub>(pigs)<\/jats:sub>\u2009=\u2009304, N<jats:sub>(cattle)<\/jats:sub>\u2009=\u200959) from food industry cadavers were exposed by microsurgical dissection following euthanasia. After rinsing with Ringer's lactate, they were tempered at 22\u00a0\u00b0C. Signal evaluation using C-IONM was performed for 10\u00a0min at 2\u00a0min intervals, and traction forces of up to 2N were applied for a median time of 60\u00a0s. Based on their post-traumatic electrophysiological response, RLNs were classified into four groups: Group A: Amplitude\u2009\u2265\u2009100%, Group B: loss of function (LOS) 0\u201325%, Group C:\u2009\u2265\u200925\u201350%, and Group D:\u2009&gt;\u200950%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A viable in-vitro neuromonitoring system was established. The median post-traumatic amplitudes were 112%, 88%, 59%, and 9% in groups A, B, C, and D, respectively. A time-dependent further dynamic LOS was observed during the 10\u00a0min after cessation of strain. Surprisingly, following initial post-traumatic hyperconductivity, complete LOS occurred in up to 20% of the nerves in group A. The critical threshold for triggering LOS was 2N in all four groups, resulting in immediate paralysis of up to 51.4% of the nerves studied.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Consistent with in-vivo studies, RLN exhibit significant intrinsic electrophysiological variability in response to tensile forces. Moreover, nerve damage progresses even after the complete cessation of strain. Up to 20% of nerves with transiently increased post-traumatic amplitudes above 100% developed complete LOS, which we termed the \"weepy cry.\" This time-delayed response must be considered during the interpretation of C-IONM signals.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00423-024-03240-z","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T03:02:58Z","timestamp":1711076578000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The weepy cry \u2013 short neural signal bursts in intraoperative neuromonitoring"],"prefix":"10.1007","volume":"409","author":[{"given":"Philipp C. 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