Twenty-year experience of paediatric thyroid surgery using intraoperative nerve monitoring

BackgroundThere are few data on intermittent and continuous intraoperative nerve monitoring (IONM) during thyroidectomy in children. MethodsAll children aged 18years or younger who had standard thyroid operations using intermittent or continuous IONM between January 1998 and December 2016 were included in the study. The impact of age and type of IONM on basal amplitude, latency and complications after thyroidectomy were assessed. ResultsA total of 504 children were included in the study. With continuous IONM, median basal amplitude and latency increased significantly with age, more on the left side (from 199 to 870V, and from 388 to 575ms) than on the right (from 340 to 778V, and from 263 to 350ms). Compared with intermittent IONM with needle electrode, continuous IONM with tube electrode resulted in an increase in median basal amplitude in children aged 13-18years on both sides (from 675 to 778V on the right and from 450 to 870V on the left), and a decrease in median latency in all children older than 3years: in children aged 4-6years, from 420 to 300ms on the right and from 610 to 463ms on the left; in children aged 7-12years, from 460 to 350ms and from 600 to 525ms respectively; and in children aged 13-18years, from 460 to 350ms and from 640 to 575ms. Overall, wound infection, but not bleeding/haematoma or vocal fold palsy, affected younger children more: 3 per cent of children aged 3years or less; 2 per cent of children aged 4-6years; and 0 per cent of children aged over 6years (P=0031). With continuous IONM, no wound infection, bleeding/haematoma or permanent vocal fold palsy was noted in any age group. ConclusionContinuous IONM measures nerve electrophysiology more accurately than intermittent IONM during thyroidectomy in children. Smaller tools needed