Yusuf YAĞMUR, Edip Erdal YILMAZ, Serdar GÜMÜŞ

Tiroid Cerrahisinde Aralıklı İntraoperatif Nöromonitorizasyonun Elektromiyografik Özellikleri

Amaç: Bu çalışmanın amacı aralıklı intraoperatif sinir monitorizasyonunun (I-IONM) püf noktalarını özetlemek ve anatomik uzunlukları birbirinden farklı olan sol ve sağ rekürren laringeal sinirin (RLN) elektrofizyolojik özelliklerini belirlemektir. Materyal ve Metot: Haziran 2016-Haziran 2017 tarihleri arasında I-IONM kullanan 34 tiroidektomili hasta (27'i total tiroidektomili, 7'i hemitiroidektomili) retrospektif olarak incelendi. Pre-disseksiyon (R1, V1) ve post-disseksiyon (R2, V2) sağ ve sol tarafın vagal siniri (VN) ve RLN'nin EMG dalga formları değerlendirildi. Bulgular: Yaş ortalaması 43.85±13.86 olan 29 kadın ve 5 erkek hasta vardı. 61 sinir I-IONM ile başarıyla değerlendirildi. Sağ RLN'nin R1 ve R2 genlikleri ortalaması sırasıyla 280±10 μV ve 270±9 μV idi; sol RLN sırasıyla 270±10 μV ve 260±9 μV idi. Sağ VN'nin ortalama V1 ve V2 genlikleri sırasıyla 210±7 μV ve 190±7 μV idi; sol VN sırasıyla 190±5.4 μV ve 170±5 μV idi. Sağ RLN'nin ortalama R1 ve R2 gecikmeleri sırasıyla 2.03±0.42 mS ve 2.0±0.46 mS; sol RLN sırasıyla 1.90±0.30 mS ve 1.96±0.33 mS idi. Sağ VN'nin ortalama V1 ve V2 latensleri sırasıyla 1.91±0.46 mS ve 1.82±0.52 mS idi; sol VN sırasıyla 2.01±0.34 mS ve 2.07±0.38 mS idi. VN ve RLN'nin EMG dalga formları açısından taraflar arasında istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Sol RLN'nin sağ RLN'den daha uzun anatomik uzunluğu vardır, ancak sinirin uzunluğunun genlik ve gecikmeyi etkilemediği sonucuna vardık.

ELECTROMYOGRAPHIC FEATURES OF INTERMITTENT INTRAOPERATIVE NEUROMONITORIZATION IN THE THYROID SURGERY

Aim: The aims of this study are, to summarize the trick points of intermittent intraoperative neuromonitoring (I-IONM), outlines ofelectrophysiologic outcomes of electromyography (EMG), and to determine the electrophysiological properties of left and right recurrentlaryngeal nerve (RLN) which anatomical lengths are different from each other.Materials and Methods: 34 thyroidectomy cases (27 of total thyroidectomy, 7 of hemithyroidectomy) with use of I-IONM, between June2016 and June 2017 were retrospectively examined. Pre-dissection (R1, V1) and post-dissection (R2, V2) EMG waveforms of the rightand left sides' vagal nerve (VN) and RLN were evaluated.Results: There were 29 females and 5 males patients with mean age of 43.85±13.86 years. 61 nerves at risk were successfullyevaluated with I-IONM. Mean R1 and R2 amplitudes of the right RLN were 280±10 μV and 270±9μV; the left RLN were 270±10μV and260±9μV respectively. Mean V1 and V2 amplitudes of the right VN were 210±7μV and 190±7μV; the left VN were 190±5.4μV and170±5μV respectively. Mean R1 and R2 latencies of the right RLN were 2.03±0.42mS and 2.0±0.46mS; the left RLN were 1.90 ±0.30mS and 1.96 ± 0.33mS respectively. Mean V1 and V2 latencies of the right VN were 1.91±0.46mS and 1.82±0.52mS; the left VNwere 2.01±0.34mS and 2.07±0.38mS respectively. There was no statistically significant difference between the sides in terms of EMGwaveforms of the VN and RLN

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