신호소실과 단계적 갑상선절제술

Loss of signal and staged thyroidectomy

Intraoperative nerve monitoring (IONM) provides dynamic neural information and is recommended for high-risk thyroid surgery. If RLN is severely injured during the operation, most nerve fibers do not transmit nerve impulse and substantial decrease of EMG amplitude or loss of signal (LOS) will occur. However, surgeon should differentiate the true LOS from false LOS, because it can be false due to various reason. If LOS is true, the decision to perform contralateral surgery to prevent bilateral vocal cord paralysis should be prudent. The updated causes, algorithm, and management of LOS during IONM and potential benefit of staged thyroidectomy are reviewed and summarized.