Individualized Supramaximal Stimulation Current During Continuous Neuromonitoring in Thyroid Surgery

Continuous intraoperative neuromonitoring (C-IONM) is increasingly used during thyroid surgery to detect early changes in recurrent laryngeal nerve function and reduce the risk of nerve injury. Current clinical practice recommends the use of fixed supramaximal stimulation currents; however, these recommendations are based on limited experimental evidence and may not account for individual variability between patients. This retrospective observational cohort study aims to determine patient-specific supramaximal stimulation currents (SSC) during C-IONM and to evaluate whether individualized stimulation provides monitoring quality comparable to conventional fixed-current stimulation while potentially reducing unnecessary stimulation intensity. The study also investigates factors influencing electromyographic response amplitudes during surgery and assesses the safety of individualized stimulation parameters.

Inclusion Criteria: * Adults aged 18 years or older. * Patients undergoing thyroid surgery with continuous intraoperative neuromonitoring (C-IONM) of the vagus nerve. * Availability of complete intraoperative neuromonitoring recordings suitable for analysis. * Availability of complete clinical and operative data. Exclusion Criteria: * Age younger than 18 years. * Incomplete or technically inadequate neuromonitoring recordings. * Loss of signal or recurrent laryngeal nerve palsy preventing reliable amplitude analysis. * Missing or incomplete clinical data required for the study.