Intraoperative neuro-monitoring has been widely adopted to facilitate the identification and preservation of recurrent laryngeal nerve function during thyroid surgery. More interesting is neuro-monitoring during reoperative neck surgery as in thyroid cancer recurrencies. Potential complications from lateral neck dissection include injury to the spinal accessory nerve, cervical plexus, hypoglossal and phrenic nerve. Such morbidity significantly increases in reoperative surgery.

Neuro-monitoring was performed using NIMS with laryngeal surface electrodes during reoperative neck dissection, for recurrent thyroid cancer with nodal involvement, in a 58 year old male patient. Total thyroidectomy and right lateral neck dissection, for papillary thyroid carcinoma, was performed 9 years before. Pre-operative ultrasound images showed the most evident lymphadenopaties in the II, III, IV and V levels. Skin incision was performed following the previous intervention scar. The lateral retraction of the sterno-cleido-mastoid muscle provided a complete exposure of the lateral compartment.

During lateral neck dissection nerves were identified with NIMS. At the end of the operation monitoring of the cervical plexus and the spinal accessory nerve showed the anatomic integrity of all nervous neck structures. 54 nodes were dissected: 13 of them were positive.

There are pitfalls associated with the use of intraoperative neuro-monitoring during thyroid surgery. Routine application of intraoperative neuro-monitoring in thyroidectomies is not recommended except for selected high risk cases as recurrent goiters and thyroid cancer recurrencies.