Abstract

Background

Intraoperative neurological monitoring is important in locating and assessing nerves during surgery. This study aimed to investigate the feasibility of neural monitoring during ultrasound-guided radiofrequency ablation (RFA) of thyroid nodules.

Methods

From February 2019 to August 2019, 16 patients (age, 42.8 ± 15.9 years; range, 17–74 years) with benign thyroid nodules who underwent ultrasound-guided RFA with neural monitoring in Zhongshan Hospital, Xiamen University, were included. A neuromonitoring system stimulated the vagus nerve to obtain electromyographic (EMG) signals and predict the function of recurrent laryngeal nerves (RLNs) during RFA. The hydrodissection technique was used to protect the RLN area. Thyroid nodules were treated with the moving-shot technique. The EMG signal value results were recorded and analyzed. All patients underwent laryngoscopic investigation 1 day after the procedure.

Results

Twenty vagus nerves were stimulated preprocedure and postprocedure, and the EMG signals were successfully recorded (100%). The mean initial (before ablation) and final (final ablation) vagus nerve amplitudes were 612.7 ± 130.4 μV (range, 455–882 μV) and 592.7 ± 127.3 μV (range, 410–817 μV), respectively. Based on the EMG signals, all 20 RLNs were judged to be in good condition, consistent with the postprocedure laryngoscopic results. The maximum lesion size and volume at 6 months after RFA were significantly lesser than those at baseline (p < 0.05). The volume reduction rate was 68.5% ± 21.5% (range, 13.0–97.3%). Cosmetic and symptom scores were significantly lower than those at baseline. No complications from neural monitoring occurred.

Conclusions

Neural monitoring during ultrasound-guided RFA of thyroid nodules is feasible to predict RLN function.

中文翻译：

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超声引导甲状腺结节射频消融期间的神经监测

摘要

背景

术中神经系统监测对手术中神经的定位和评估很重要。这项研究旨在调查在甲状腺结节的超声引导射频消融（RFA）期间进行神经监测的可行性。

方法

从2019年2月至2019年8月，包括16例（良性甲状腺结节）患者（年龄42.8±15.9岁；范围17-74岁），他们在厦门大学中山医院接受了超声引导下的RFA神经监测。神经监视系统刺激迷走神经以获得肌电图（EMG）信号并预测RFA期间喉返神经（RLNs）的功能。水解剖技术用于保护RLN区域。甲状腺结节采用动弹技术治疗。记录并分析肌电信号值结果。所有患者在手术后1天接受喉镜检查。

结果

术前和术后刺激了20只迷走神经，并成功记录了肌电信号（100％）。初始（消融前）和最终（最终消融）迷走神经平均幅度分别为612.7±130.4μV（范围455-882μV）和592.7±127.3μV（范围410-817μV）。根据EMG信号，判断所有20个RLN状况良好，与术后喉镜检查结果一致。RFA后6个月的最大病变大小和体积明显小于基线（p  <0.05）。体积减少率为68.5％±21.5％（范围为13.0-97.3％）。外观和症状评分明显低于基线时。没有发生神经监测并发症。

结论

在超声引导的甲状腺结节RFA期间进行神经监测可预测RLN功能。