Table Of ContentIntraoperative Cranial
Nerve Monitoring in
Otolaryngology-Head
and Neck Surgery
Joseph Scharpf
Gregory W. Randolph
Editors
123
Intraoperative Cranial Nerve
Monitoring in Otolaryngology-Head and
Neck Surgery
Joseph Scharpf • Gregory W. Randolph
Editors
Intraoperative Cranial
Nerve Monitoring in
Otolaryngology-Head
and Neck Surgery
Editors
Joseph Scharpf Gregory W. Randolph
Head and Neck Institute Otolaryngology-Head and Neck Surgery
Cleveland Clinic Massachusetts Eye and Ear Infirmary
Cleveland, OH Boston, MA
USA USA
ISBN 978-3-030-84915-3 ISBN 978-3-030-84916-0 (eBook)
https://doi.org/10.1007/978-3-030-84916-0
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I would like to dedicate this book to my wife Tanya P Scharpf
for her enduring love and support in my career and life. Her
faith and selfless devotion to our family have made all things
possible.
I am also so grateful for my children Joseph and Alexandra,
whose love, compassion, and understanding inspire me each
day and are a blessing to me.
I finally want to thank my parents Joseph and Teresa Scharpf
for all their love and sacrifices to provide opportunities for me
and encourage me to pursue a career in medicine.
—Joseph Scharpf
To my wife, Lorraine, your living faith and love has given me
strength. Your faith, hard work, and selfless devotion to others
has been my guiding light on this our path together.
To my children, Gregory, your artistic lens on the world has
taught me. Benjamin, I’m proud of the man you have become
and your abiding concern for others. Madeline, your
intelligence, accomplishments, and grace through all inspire
me.
To my mother, Frances, you have fostered a hopeful strength
and a desire to learn.
—Gregory W. Randolph
Preface
Advances in intraoperative cranial nerve monitoring in Otolaryngology-Head
and Neck Surgery have resulted in the optimization of patient outcomes and
have improved the safety profile for our surgeries in the head and neck. There
has been an expansion in both clinical applications and indications for nerve
monitoring in the head and neck. Continuous innovation in the field has been
led by many dedicated specialists contributing to this book including mem-
bers of the International Neuromonitoring Study Group, founded by Dr.
Gregory Randolph and Professor Henning Dralle. The Task Force on Cranial
Nerve Monitoring of the American Academy of Otolaryngology-Head and
Neck Surgery (AAOHNS) has provided further support for nerve monitoring
with its position statement and task force report.
This book was conceived to fill the void that existed in having one source
accessible to practitioners and trainees dedicated to intraoperative nerve
monitoring. The book draws upon internationally recognized experts to elu-
cidate the values, techniques, and limitations of intraoperative cranial nerve
monitoring in head and neck surgery. It is our hope that this book will serve
to further the knowledge of surgeons and multidisciplinary teams in their
pursuit of providing their patients with the best care possible. We also hope
that it will inspire future research and efforts to improve upon our existing
knowledge to help the patients of tomorrow.
Finally, we would like to thank our students, residents, and fellows, whom
we have been privileged to mentor and train over the courses of our careers,
and to our patients who have been so appreciative of the value that intraopera-
tive nerve monitoring brings to their care. We would also like to thank
Samantha Lonuzzi from Springer for her support in bringing this work to
fruition.
Cleveland, OH, USA Joseph Scharpf
Boston, MA, USA Gregory W. Randolph
vii
Contents
Part I Nerve Monitoring Principles
1 Historical Perspective on Nerve Monitoring During Head and
Neck Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Jeffrey Mella and David C. Shonka Jr.
2 Basic and Advanced Electrophysiology, Setup, and Anesthesia . 19
Kirsten F. A. A. Dabekaussen, Pavan Mallur, and
Jennifer J. Shin
3 Anesthetic Considerations and Setup for Cranial Nerve
Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Anisha Rhea Noble and Juliana Bonilla-Velez
4 Neural Injury Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Kevin J. Contrera, Tomislav Novosel, and Joseph Scharpf
5 Neuromonitoring Usage Patterns and Education . . . . . . . . . . . . 51
Michael C. Singer
Part II Vagus/Recurrent Laryngeal Nerve Monitoring
6 Rationale and Indications for Vagus/Recurrent
Laryngeal Nerve Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Che-Wei Wu, Feng-Yu Chiang, Amanda Silver Karcioglu,
Ayaka J. Iwata, Amr H. Abdelhamid Ahmed, and
Gregory W. Randolph
7 Methods of Recurrent Laryngeal Nerve Monitoring . . . . . . . . . . 73
Betty Y. Chen and Brendan C. Stack
8 Monitoring of the Superior Laryngeal Nerve. . . . . . . . . . . . . . . . 83
Claudio R. Cernea, Erivelto M. Volpi, and Marcin Barczynski
9 Intraoperative Cranial Nerve Monitoring in
Otolaryngology – Head and Neck Surgery . . . . . . . . . . . . . . . . . . 89
Rick Schneider, Leonardo Rangel, and Antonio Bertelli
ix
x Contents
10 Emerging Trends for Vagus/Recurrent Laryngeal Nerve
Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Vaninder K. Dhillon and Catherine F. Sinclair
11 Troubleshooting System Integrity . . . . . . . . . . . . . . . . . . . . . . . . . 107
Douglas M. Bennion and Nitin A. Pagedar
12 Loss of Neural Signal in Thyroid and Parathyroid Surgery . . . . 117
Simon A. Holoubek and David J. Terris
13 Recurrent Laryngeal Nerve Monitoring and
Decision-Making in Advanced Thyroid Cancer . . . . . . . . . . . . . . 123
Garren M. I. Low, Richard J. Wong, and Mark Zafereo
14 Nerve Monitoring in Remote Access Thyroid Surgery . . . . . . . . 133
Nicholas R. Scott-Wittenborn, Areej Shihabi,
Jonathon O. Russell, Emad Kandil, and Ralph Tufano
15 Nerve Monitoring During Parathyroid Surgery . . . . . . . . . . . . . 141
Phillip K. Pellitteri and Nicholas C. Purdy
Part III F acial Nerve, Glossopharyngeal Nerve, Hypoglossal
Nerve, Brachial Plexus and Spine Monitoring
16 Facial Nerve Monitoring: Extratemporal Facial Nerve . . . . . . . 151
Julia E. Noel and Lisa A. Orloff
17 Spinal Accessory Nerve Monitoring in Head and
Neck Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Nicole Molin and Jeffrey C. Liu
18 Glossopharyngeal (CN IX) and Hypoglossal (CN XII)
Nerve Stimulation and Monitoring . . . . . . . . . . . . . . . . . . . . . . . . 163
Maria V. Suurna and David L. Steward
19 Brachial Plexus and Spinal Nerve Monitoring . . . . . . . . . . . . . . . 171
Arbaz A. Momin, Maxwell Y. Lee, Navkiranjot Kaur, and
Michael P. Steinmetz
Part IV M iscellaneous Nerve Monitoring Considerations
20 Documentation and Reimbursement . . . . . . . . . . . . . . . . . . . . . . . 189
Whitney Liddy
21 Ethical Considerations for Nerve Monitoring . . . . . . . . . . . . . . . 195
Peter Angelos
22 Nerve Monitoring and Medical Malpractice . . . . . . . . . . . . . . . . 201
Allison Keane and David Goldenberg
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Contributors
Amr H. Abdelhamid Ahmed Division of Thyroid and Parathyroid
Endocrine Surgery, Department of Otolaryngology-Head & Neck Surgery,
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA,
USA
Peter Angelos Department of Surgery and MacLean Center for Clinical
Medical Ethics, The University of Chicago, Chicago, IL, USA
Marcin Barczynski Department of Endocrine Surgery, Third Chair of
General Surgery, Jagiellonian University Medical College, Krakow, Poland
Douglas M. Bennion Department of Otolaryngology – Head and Neck
Surgery, University of Iowa, Iowa City, IA, USA
Antonio Bertelli Department of Surgery, Head and Neck Surgery Division,
Santa Casa de Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil
Juliana Bonilla-Velez Department of Otolaryngology–Head and Neck
Surgery, University of Washington School of Medicine, Seattle, WA, USA
Division of Pediatric Otolaryngology, Seattle Children’s Hospital, Seattle,
WA, USA
Center for Clinical and Translational Research, Seattle Children’s Research
Institute, Seattle, WA, USA
Claudio R. Cernea Department of Surgery, University of São Paulo School
of Medicine, São Paulo, Sao Paulo, Brazil
Betty Y. Chen Department of Otolaryngology-Head and Neck Surgery,
Southern Illinois University School of Medicine, Springfield, IL, USA
Feng-Yu Chiang Department of Otolaryngology, E-Da Hospital, School of
Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
Kevin J. Contrera Head and Neck Institute, Cleveland Clinic, Cleveland,
OH, USA
Kirsten F.A.A. Dabekaussen Department of Surgery, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA
Vaninder K. Dhillon Division of Laryngology and Endocrine Head and
Neck Surgery, Johns Hopkins University, Department of Otolaryngology-
Head and Neck Surgery, Bethesda, MD, USA
xi
xii Contributors
David Goldenberg The Department of Otolaryngology-Head and Neck
Surgery, The Pennsylvania State University, The Milton S. Hershey Medical
Center, Hershey, PA, USA
Simon A. Holoubek Department of Otolaryngology – Head and Neck
Surgery, Augusta University, Augusta, GA, USA
Ayaka J. Iwata Department of Otolaryngology-Head and Neck Surgery,
Kaiser Permanente, Santa Clara, CA, USA
Emad Kandil Department of Surgery, Tulane University School of
Medicine, New Orleans, LA, USA
Amanda Silver Karcioglu Division of Thyroid and Parathyroid Endocrine
Surgery, Department of Otolaryngology-Head & Neck Surgery, Massachusetts
Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
Navkiranjot Kaur Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Education Institute, Cleveland Clinic, Cleveland,
OH, USA
Allison Keane The Department of Otolaryngology-Head and Neck Surgery,
The Pennsylvania State University, The Milton S. Hershey Medical Center,
Hershey, PA, USA
Maxwell Y. Lee Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Education Institute, Cleveland Clinic, Cleveland,
OH, USA
Whitney Liddy Department of Otolaryngology – Head and Neck Surgery,
Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Jeffrey C. Liu Department of Otolaryngology Head and Neck Surgery,
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia,
PA, USA
Garren M.I. Low Department of Otorhinolaryngology-Head and Neck
Surgery, University of Texas Health Sciences Center at Houston, Houston,
TX, USA
Pavan Mallur Department of Otolaryngology, Harvard Medical School,
Boston, MA, USA
Jeffrey Mella University of Virginia, Department of Otolaryngology, Head
and Neck Surgery, Charlottesville, VA, USA
Nicole Molin Department of Otolaryngology Head and Neck Surgery, Lewis
Katz School of Medicine at Temple University, Philadelphia, PA, USA
Arbaz A. Momin Cleveland Clinic Lerner College of Medicine of Case
Western Reserve University, Education Institute, Cleveland Clinic, Cleveland,
OH, USA
