Actually, none IONM technique applied in any field of general surgery [as in neurosurgery, orthopedics, spinal surgery, ear, nose, throat (ENT), facial nerve, vascular] acquire class I evidence (1).
Furthermore, IONM should be equalized at same level of significance of any other technology applied to most our clinical practice within thyroid and parathyroid surgery as for the use of energy based devices, endoscopy, robotic, intact parathyroid hormone (iPTH) measurement, thermal ablation, screening (1-7).
For IONM to be valuable (I) must furnish instantly information of impending recurrent laryngeal nerve (RLN) damage early enough to permit the thyroid surgeon to take conveniently measures to inverse or underrate the harm (II) simply to adapt, perform and read, (III) accessible resource (IV) cost-effective (1-7).
Practically, evidence-based measures for IONM in thyroid surgery protocol studies hardly can incorporate surgeon clinical emprise (i.e., optimization of nerve dissection) and intraoperative decision making (i.e., avoidance of bilateral RLN injury), patient expense for RLN injury, and pathophysiologic rationale (i.e., research).
Unlikely class I protocol studies will ever occur again after the one by Barczyński et al. (8,9). The likelihood of preventing RLN injury using IONM and the incidence of permanent RLN complications is very low (8,9). One randomized study evaluated prospectively IONM in thyroid surgery. The prevalence of transient RLN paresis was lower in patients who had RLN monitoring by 2.9 percent in high-risk patients (P=0.011) and 0.9 percent in low-risk patients (P=0.249) (8,9).
Conflicts of Interest: The authors have no conflicts of interest to declare.
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Cite this article as: Zanghì GN, Sun H, Dionigi G. Evidence-based medicine measures for neural monitoring in thyroid surgery. Ann Thyroid 2018;3:10.