Trend-Based Intermittent Neuromonitoring in Thyroid and Parathyroid Surgery: A Prospective Preliminary Observational Study

Background/Objectives: Intraoperative neuromonitoring (IONM) has improved safety in thyroid and parathyroid surgery, yet intermittent IONM (I-IONM) may miss traction injuries developing between stimulations. We evaluated the feasibility and clinical utility of a trend-based intermittent monitoring mode (NIM Vital NerveTrend®) that records closely spaced stimulations and plots amplitude and latency over time. Methods: We conducted a prospective observational study at a high-volume endocrine surgery unit (January–September 2025). Forty-four consecutive patients undergoing thyroidectomy and/or parathyroidectomy with NerveTrend® were enrolled. EMG responses were categorized as Green (amplitude >50% of baseline and latency < 110%), Yellow (amplitude < 50% or latency >110%), Red (amplitude < 50% and latency >110%), and Loss of Signal (LOS: amplitude < 100 µV). Primary outcomes included LOS prevalence and the association between stimulation frequency and the appearance of Yellow trends. Ethical approval: AVEN protocol 486/2024/OSS/AOUPR; informed consent obtained. Results: Of 71 nerves at risk (NAR), 55 had a valid baseline and were analyzed; LOS occurred in 3/55 NAR (5.5%). The mean number of stimulations per NAR was 4.5 (range 1–9). Cases with both Green and Yellow points had a significantly higher mean number of stimulations than cases with only Green points (5.1 vs. 3.8; Student's t-test p = 0.0059). One Red measurement occurred in a case that progressed to LOS. Conclusions: NerveTrend® provided near real-time functional feedback while maintaining the simplicity of I-IONM. Increased stimulation frequency was associated with early Yellow trend alerts, potentially signaling traction stress and enabling timely surgical adjustments. Larger multicenter studies and protocol standardization are warranted.