International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal

Laryngoscope. 2018 Oct;128 Suppl 3:S1-S17. doi: 10.1002/lary.27359. Epub 2018 Oct 5.


This publication offers modern, state-of-the-art International Neural Monitoring Study Group (INMSG) guidelines based on a detailed review of the recent monitoring literature. The guidelines outline evidence-based definitions of adverse electrophysiologic events, especially loss of signal, and their incorporation in surgical strategy. These recommendations are designed to reduce technique variations, enhance the quality of neural monitoring, and assist surgeons in the clinical decision-making process involved in surgical management of recurrent laryngeal nerve. The guidelines are published in conjunction with the INMSG Guidelines Part II, Optimal Recurrent Laryngeal Nerve Management for Invasive Thyroid Cancer-Incorporation of Surgical, Laryngeal, and Neural Electrophysiologic Data. Laryngoscope, 128:S1-S17, 2018.

Keywords: IONM; Thyroid surgery; bilateral thyroid surgery; intraoperative neural monitoring; laryngeal exam; loss of signal; staged surgery; vocal cord paralysis.

Publication types

  • Practice Guideline
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Humans
  • Intraoperative Complications / etiology
  • Intraoperative Complications / prevention & control*
  • Intraoperative Neurophysiological Monitoring / methods
  • Intraoperative Neurophysiological Monitoring / standards*
  • Recurrent Laryngeal Nerve / surgery*
  • Recurrent Laryngeal Nerve Injuries / etiology
  • Recurrent Laryngeal Nerve Injuries / prevention & control*
  • Thyroid Gland / innervation
  • Thyroid Gland / surgery
  • Thyroidectomy / adverse effects
  • Thyroidectomy / methods
  • Thyroidectomy / standards*
  • Vocal Cord Paralysis / etiology
  • Vocal Cord Paralysis / prevention & control*