Clinical Application of Continuous Intraoperative Neuromonitoring during Thyroid Surgery

Routine visual identification of the recurrent laryngeal nerve (RLN) is the gold standard of care during thyroidectomy because it is associated with low rates of RLN palsy. Over the last two decades, intraoperative neuromonitoring (IONM), which allows for assessment of the RLN’s functional integrity during the operation, has been widely used for risk minimization in thyroid surgery as a valuable adjunct to visual nerve identification. Currently, one of the most important trends in IONM is the real-time monitoring of the vagus nerve (VN) to prevent iatrogenic injury of RLN. Continuous IONM (C-IONM) seems to be superior to intermittent IONM (I-IONM) because it enhances standardization by permanent VN stimulation and provides entire and constant RLN function monitoring during thyroidectomy procedures. In this article, we provide a comprehensive review of the C-IONM technique.