Effectiveness of spinal accessory intraoperative nerve monitoring during neck dissections
Vol. 67 No. 1 (2021), ORIGINAL ARTICLES. C. CLINICAL RESEARCH
Vol. 67 No. 1 (2021)

Effectiveness of spinal accessory intraoperative nerve monitoring during neck dissections

ORIGINAL ARTICLES. C. CLINICAL RESEARCH
https://doi.org/10.37469/0507-3758-2021-67-1-64-69
Published 03.03.2022
Kristina Vabalayte
St. Petersburg Pediatric Medical University
Professor
St. Petersburg Pediatric Medical University
pdf (Русский)

Keywords

thyroid cancer
intraoperative neuromonitoring
spinal accessory nerve

How to Cite

Vabalayte, K., & Romanchishen, A. (2022). Effectiveness of spinal accessory intraoperative nerve monitoring during neck dissections. Voprosy Onkologii, 67(1), 64–69. https://doi.org/10.37469/0507-3758-2021-67-1-64-69
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Abstract

The aim of the study is to evaluate the efficiency and safety of intraoperative neuromonitoring (IONM) of accessory nerves during lateral lymphodissection (LLD).

Materials and Methods. Main group consisted of 63 patients with thyroid cancer (TC) with confirmed metastatic spread into cervical lymph nodes of II-V groups, and which underwent IONM of accessory nerve during LLD. Control group consisted of 60 patients in which no IONM was performed during LLD. Main group consisted of 21 males (33.3%); 42 females (66.7%): mean age 50.7 ± 8,7. Control group consisted of 11 males (18.2%); 49 females (81.8%); mean age 47.2 ± 6,8.

Results. All patients of main group responded to electric stimulation of accessory nerve during IONM. 58 (92.1%) patients did not present new symptom, whereas 4 (6.3%) noted a moderate pain while lifting and stretching the upper extremity during two weeks. In 1 (1.6%) - temporary difficulty in arm abduction up to 90° was observed. In control group, in 5 (8.3%) - damage to accessory nerve was found which manifested as lack of contraction of trapezius muscle in response to electric stimulus. In 12 (20%) - pain during lifting and abduction of upper extremity on respective side was observed up to 3-4 weeks after surgery.

Conclusions. IONM of accessory nerve is a safe and effective way to reduce probability of accessory nerve damage, which, together with improvement in organ-preserving techniques, is demonstrated by decrease of functional loss in upper extremities from 13.3% to 1.6% during the period from 2000 to 2020.

https://doi.org/10.37469/0507-3758-2021-67-1-64-69
pdf (Русский)

References

Романчишен А.Ф., Багатурия Г.О., Вабалайте К.В., Сокуренко Г.Ю. Местно-распространенный рак щитовидной железы: диагностика, лечение, отдаленные и непосредственные результаты: учебное пособие. СПб: СпецЛит, 2017: 175 Romanchishen A.F., Bagaturija G.O., Vabalayte K.V., Sokurenko G.Ju. Mestno-rasprostranennyj rak shhitovidnoj zhelezy: diagnostika, lechenie, otdalennye i neposredstvennye rezul'taty: uchebnoe posobie. SPb: SpecLit, 2017: 175 (In Russ.).

Kim S.Y., Kim B-W., Pyo J.Y. et al. Macrometastasis in Papillary Thyroid Cancer Patients is Associated with Higher Recurrence in Lateral Neck Nodes.World J Surg. 2018; 42:123–129. https://doi.org/10.1007/s00268-017-4158-5.

Randolph G.W. Surgery of thyroid and parathyroid gland. 2nd ed. Philadelphia: Elsevier Saunders, 2013.

Crile G. Excision of cancer. JAMA. 1906; 47: 1780-1786 https://doi.org/10.1001/jama.1906.25210220006001a

Marchetta F.C., Sako K., Matsuura H. Modified neck dissection for carcinoma of the thyroid gland. Am J Surg. 1970; 120 (4): 452-455. https://doi.org/10.1016/s0002-9610(70)80005-8.

Sako K., Marchetta F.C., Razack M.S., Shedd D.P. Modified radical neck dissection for metastatic carcinoma of the thyroid. A reappraisal. Am J Surg. 1985; 150 (4): 500-502. https://doi.org/10.1016/0002-9610(85)90163-1.

MacFee W.F. Transverse incisions for neck dissection. Plastic and Reconstructive Surgery. 1960; 26(2):242. https://doi.org/10.1097/00006534-196008000-00019.

Романчишен А.Ф., Гостимский А.В., Мосягин В.Б. и др. Оперативные доступы в экстренной и плановой хирургии органов шеи. Хирургия. 2018; (5): 75-80 Romanchishen A.F., Gostimsky A.V., Mosyagin V.B. et al. Surgical approaches in urgent and elective surgery of the neck. Khirurgiia (Mosk). 2018; (5):75-80. https://doi.org/10.17116/hirurgia2018575-80 (In Russ.).

Романчишен А.Ф., Вабалайте К.В., Романчишен Ф.А., Карпатский И.В. Первый опыт в России использования эстетических доступов и интраоперационного нейромониторинга возвратных гортанных и добавочных нервов при операциях по поводу рака щитовидной железы и рецидивного зоба у детей. Педиатр. 2017; 8 (S1): M278-M279 Romanchishen A.F., Vabalayte K.V., Romanchishen F.A., Karpatsky I.V. Pervyi opyt v Rossii ispol'zovaniya esteticheskikh dostupov i intraoperatsionnogo neiromonitoringa vozvratnykh gortannykh i dobavochnykh nervov pri operatsiyakh po povodu raka shchitovidnoi zhelezy i retsidivnogo zoba u detei. Pediatr. 2017; 8 (S1): M278-M270 (In Russ.).

Witt R.L., Gillis T., Pratt R, Jr. Spinal accessory nerve monitoring with clinical outcome measures. Ear Nose Troat J. 2006;85:540-544. https://doi.org/10.1177/014556130608500820.

Witt R.L., Rejto L. Spinal accessory nerve monitoring in selective and modified neck dissection. Laryngoscope. 2007; 117:776-780. https://doi.org/10.1097/mlg.0b013e3180341a0c.

Dillon F.X. Electromyographic (EMG) neuromonitoring in otolaryngology head and neck surgery. Anesthesiol Clin. 2010. 2010; 28:423-442. https://doi.org/10.1016/j.anclin.2010.07.011.

Birinci Y., Genc A., Ecevit M.C. et al. Spinal Accessory nerve monitoring and clinical outcome result of nerve-sparing neck dissection. Head and Neck Surgery. 2014; 151(2):253-259. https://doi.org/10.1177/0194599814531021.

Румянцев П.О. Интраоперационный нейромониторинг при операциях на щитовидной железе. Эндокринная хирургия. 2012; 6 (2):42-47 Rumyantsev P.O. Intraoperative neuromonitoring in thyroid surgery. Endocrine surgery. 2012; 6 (2): 42-47. https://doi.org/10.14341/2306-3513-2012-2-42-47 (In Russ.).

Kupferman M.E., Patterson D.M., Mandel S.J. et al. Safety of modified radical neck dissection for differentiated thyroid carcinoma. Laryngoscope. 2004; 114: 403-406. https://doi.org/10.1097/00005537-200403000-00002.

Leipzig B., Suen J.Y., English J.L. Functional evaluation of the spinal accessory nerve after neck dissection. Am J Surg. 1983; 146:526-530. https://doi.org/10.1016/0002-9610(83)90246-5.

Remmler D., Byers R., Scheetz J. et al. A prospective study of shoulder disability resulting from radical and modified neck dissections. Head Neck Surg. 1986;8:280-286. https://doi.org/10.1002/hed.2890080408.

Erisen L., Basel B., Irdesel J. et al. Shoulder function after accessory nerve-sparing neck dissections. Head Neck. 2004;26: 967-971. https://doi.org/10.1002/hed.20095.

Koybasioglu A., Tokcaer A.B., Uslu S. et al. Accessory nerve function after modified radical and lateral neck dissections. Laryngoscope. 2000;110:73-77. https://doi.org/10.1097/00005537-200001000-00014.

Tsuji T., Tanuma A., Onitsuka T. et al. Electromyographic find- ings after different selective neck dissections. Laryngoscope. 2007;117:319-322. https://doi.org/10.1097/01.mlg.0000249781.20989.5c.

Cappiello J., Piazza C., Giudice M. et al. Shoulder disability after different selective neck dissections (levels II-IV versus levels II- V): a comparative study. Laryngoscope. 2005; 115:259-263. https://doi.org/10.1097/01.mlg.0000154729.31281.da.

Grosheva M., Wittekindt C., Guntinas-Lichius O. Prognostic value of electroneurography and electromyography in facial palsy. Laryngoscope. 2008;118:394-397. https://doi.org/10.1097/mlg.0b013e31815d8e68.

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