Advancements in intraoperative neuromonitoring for recurrent laryngeal nerve preservation in parathyroidectomy

Parathyroidectomy is a pivotal surgical intervention for managing hyperparathyroidism, necessitating meticulous precision to preserve adjacent neural structures, particularly the recurrent laryngeal nerve. Intraoperative neuromonitoring (IONM) has emerged as an essential tool in minimizing nerve injury during parathyroidectomy. This review critically evaluates current neuromonitoring strategies, assessing their effectiveness in enhancing nerve preservation. It explores various IONM modalities, including intermittent and continuous monitoring, and examines their integration into surgical protocols. Additionally, advancements in neurophysiological monitoring technologies are discussed, highlighting their impact on surgical outcomes and patient quality of life. Integrated case studies illustrate the practical applications and outcomes of IONM in parathyroidectomy. Furthermore, an analysis of future directions explores potential innovations and improvements in neuromonitoring techniques. By synthesizing existing literature, clinical practices, and empirical evidence, this manuscript underscores the indispensable role of IONM in optimizing parathyroidectomy procedures, aiming to enhance patient safety and postoperative outcomes.