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Abstract：
BACKGROUND: Enhancing patient outcomes in an array of surgical procedures in the head and neck requires the maintenance of complex regional functions through the protection of cranial nerve integrity. This review and consensus statement cover the scope of cranial nerve monitoring of all cranial nerves that are of practical importance in head, neck, and endocrine surgery except for cranial nerves VII and VIII within the temporal bone. Complete and applied understanding of neurophysiologic principles facilitates the surgeon\'s ability to monitor the at-risk nerve.
METHODS: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) identified the need for a consensus statement on cranial nerve monitoring. An AAO-HNS task force was created through soliciting experts on the subject. Relevant domains were identified, including residency education, neurophysiology, application, and various techniques for monitoring pertinent cranial nerves. A document was generated to incorporate and consolidate these domains. The panel used a modified Delphi method for consensus generation.
RESULTS: Consensus was achieved in the domains of education needs and anesthesia considerations, as well as setup, troubleshooting, and documentation. Specific cranial nerve monitoring was evaluated and reached consensus for all cranial nerves in statement 4 with the exception of the spinal accessory nerve. Although the spinal accessory nerve\'s value can never be marginalized, the task force did not feel that the existing literature was as robust to support a recommendation of routine monitoring of this nerve. In contrast, there is robust supporting literature cited and consensus for routine monitoring in certain procedures, such as thyroid surgery, to optimize patient outcomes.
CONCLUSIONS: The AAO-HNS Cranial Nerve Monitoring Task Force has provided a state-of-the-art review in neural monitoring in otolaryngologic head, neck, and endocrine surgery. The evidence-based review was complemented by consensus statements utilizing a modified Delphi method to prioritize key statements to enhance patient outcomes in an array of surgical procedures in the head and neck. A precise definition of what actually constitutes intraoperative nerve monitoring and its benefits have been provided.
METHODS: The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) identified the need for a consensus statement on cranial nerve monitoring. An AAO-HNS task force was created through soliciting experts on the subject. Relevant domains were identified, including residency education, neurophysiology, application, and various techniques for monitoring pertinent cranial nerves. A document was generated to incorporate and consolidate these domains. The panel used a modified Delphi method for consensus generation.
RESULTS: Consensus was achieved in the domains of education needs and anesthesia considerations, as well as setup, troubleshooting, and documentation. Specific cranial nerve monitoring was evaluated and reached consensus for all cranial nerves in statement 4 with the exception of the spinal accessory nerve. Although the spinal accessory nerve\'s value can never be marginalized, the task force did not feel that the existing literature was as robust to support a recommendation of routine monitoring of this nerve. In contrast, there is robust supporting literature cited and consensus for routine monitoring in certain procedures, such as thyroid surgery, to optimize patient outcomes.
CONCLUSIONS: The AAO-HNS Cranial Nerve Monitoring Task Force has provided a state-of-the-art review in neural monitoring in otolaryngologic head, neck, and endocrine surgery. The evidence-based review was complemented by consensus statements utilizing a modified Delphi method to prioritize key statements to enhance patient outcomes in an array of surgical procedures in the head and neck. A precise definition of what actually constitutes intraoperative nerve monitoring and its benefits have been provided.
摘要：
背景：在一系列头颈部外科手术中提高患者的预后需要通过保护颅神经完整性来维持复杂的区域功能。本综述和共识声明涵盖了对头部具有实际重要性的所有颅神经的颅神经监测范围，脖子,和内分泌手术，颞骨内的颅神经VII和VIII除外。对神经生理学原理的完整和应用理解有助于外科医生监测危险神经的能力。
方法：美国耳鼻咽喉头颈外科学会（AAO-HNS）确定了对颅神经监测的共识声明的必要性。通过征求有关该主题的专家，成立了AAO-HNS工作队。确定了相关领域，包括住院医师教育,神经生理学，应用程序,和监测相关颅神经的各种技术。生成了一个文档来合并和合并这些域。小组使用改进的Delphi方法进行共识生成。
结果：在教育需求和麻醉考虑方面达成了共识，以及设置，故障排除,和文档。在声明4中，除脊髓副神经外，对所有颅神经进行了特定的颅神经监测评估并达成共识。虽然脊髓副神经的价值永远不能被边缘化，专责小组认为现有文献没有足够的证据支持常规监测该神经的建议.相比之下,在某些程序中，有可靠的支持文献引用和常规监测的共识，比如甲状腺手术，优化患者预后。
结论：AAO-HNS颅神经监测工作组在耳鼻咽喉头神经监测方面提供了最新的综述，脖子,和内分泌手术。以证据为基础的审查得到了共识声明的补充，该共识声明利用改良的Delphi方法对关键声明进行优先级排序，以提高患者在一系列头颈部外科手术中的预后。已经提供了实际上构成术中神经监测的精确定义及其益处。
方法：美国耳鼻咽喉头颈外科学会（AAO-HNS）确定了对颅神经监测的共识声明的必要性。通过征求有关该主题的专家，成立了AAO-HNS工作队。确定了相关领域，包括住院医师教育,神经生理学，应用程序,和监测相关颅神经的各种技术。生成了一个文档来合并和合并这些域。小组使用改进的Delphi方法进行共识生成。
结果：在教育需求和麻醉考虑方面达成了共识，以及设置，故障排除,和文档。在声明4中，除脊髓副神经外，对所有颅神经进行了特定的颅神经监测评估并达成共识。虽然脊髓副神经的价值永远不能被边缘化，专责小组认为现有文献没有足够的证据支持常规监测该神经的建议.相比之下,在某些程序中，有可靠的支持文献引用和常规监测的共识，比如甲状腺手术，优化患者预后。
结论：AAO-HNS颅神经监测工作组在耳鼻咽喉头神经监测方面提供了最新的综述，脖子,和内分泌手术。以证据为基础的审查得到了共识声明的补充，该共识声明利用改良的Delphi方法对关键声明进行优先级排序，以提高患者在一系列头颈部外科手术中的预后。已经提供了实际上构成术中神经监测的精确定义及其益处。
