A Thoughtful Approach to IONM Outcomes Reporting

To explore how the different types of intraoperative neuromonitoring (IONM)—namely intermittent (I-IONM) and continuous (C-IONM)—differ from each other and to examine how these differences can affect expected outcomes from IONM. Intraoperative neuromonitoring (IONM) is an important surgical tool for assessment of nerve functional status during surgical procedures where a particular nerve is at risk of injury. IONM has evolved especially in the thyroid/parathyroid surgical space. Accurate use of IONM is dependent on correct set-up of the monitoring equipment and on the surgeon’s implementation and responsiveness to the information provided by the equipment. I-IONM and C-IONM are complementary and together facilitate an unparalleled window into intraoperative neural functional integrity. Rate of nerve palsy is not the only outcome to consider when designing a study to define the utility of IONM in surgery. Other outcomes that are important to consider include alterations in surgical decision making based on IONM data including staged surgical approaches and enhanced localization abilities (especially important for I-IONM techniques); temporal course of a nerve injury (especially important for C-IONM); and changes in surgical technique over time induced by intraoperative nerve functional feedback (especially important for C-IONM). The surgical team should be realistic about what they wish to achieve with IONM and choose the form IONM to be used based on these requirements.