{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T21:41:24Z","timestamp":1783633284096,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Publication fund of Martin Luther University Halle-Wittenberg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>(1) Background: Pediatric thyroidectomy is characterized by considerable space constraints, thinner nerves, a large thymus, and enlarged neck nodes, compromising surgical exposure. Given these challenges, risk-reduction surgery is of paramount importance in children, and even more so in pediatric thyroid oncology. (2) Methods: Children aged \u226418 years who underwent thyroidectomy with or without central node dissection for suspected or proven thyroid cancer were evaluated regarding suitability of intermittent vs. continuous intraoperative neuromonitoring (IONM) for prevention of postoperative vocal cord palsy. (3) Results: There were 258 children for analysis, 170 girls and 88 boys, with 486 recurrent laryngeal nerves at risk (NAR). Altogether, loss of signal occurred in 2.9% (14 NAR), resulting in six early postoperative vocal cord palsies, one of which became permanent. Loss of signal (3.5 vs. 0%), early (1.5 vs. 0%), and permanent (0.3 vs. 0%) postoperative vocal cord palsies occurred exclusively with intermittent IONM. With continuous nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy reached 100% for prediction of early and permanent postoperative vocal cord palsy. With intermittent nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy were consistently lower for prediction of early and permanent postoperative vocal cord palsy, ranging from 78.6% to 99.8%, and much lower (54.2\u201357.9%) for sensitivity. (4) Conclusions: Within the limitations of the study, continuous IONM, which is feasible in children \u22653 years, was superior to intermittent IONM in preventing early and permanent postoperative vocal cord palsy.<\/jats:p>","DOI":"10.3390\/cancers13174333","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T09:53:23Z","timestamp":1630058003000},"page":"4333","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Recurrent Laryngeal Nerve Preservation Strategies in Pediatric Thyroid Oncology: Continuous vs. Intermittent Nerve Monitoring"],"prefix":"10.3390","volume":"13","author":[{"given":"Rick","family":"Schneider","sequence":"first","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, University Hospital, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6796-079X","authenticated-orcid":false,"given":"Andreas","family":"Machens","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, University Hospital, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Sekulla","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, University Hospital, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0281-1950","authenticated-orcid":false,"given":"Kerstin","family":"Lorenz","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, University Hospital, 06120 Halle, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Dralle","sequence":"additional","affiliation":[{"name":"Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, University Hospital, 06120 Halle, Germany"},{"name":"Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.surg.2018.07.021","article-title":"Disease impacts more than age on operative morbidity in children with Graves\u2019 disease after total thyroidectomy","volume":"164","author":"Machens","year":"2018","journal-title":"Surgery"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.surg.2016.03.007","article-title":"Impact of central node dissection on postoperative morbidity in pediatric patients with suspected or proven thyroid cancer","volume":"160","author":"Machens","year":"2016","journal-title":"Surgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e150","DOI":"10.1002\/bjs.10746","article-title":"Long-term outcome of prophylactic thyroidectomy in children carrying RET germline mutations","volume":"105","author":"Machens","year":"2018","journal-title":"Br. 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