Continuous Intra-Arterial Blood Pressure Monitoring Improves the Efficiency of Percutaneous Balloon Compression of the Trigeminal Ganglion for Trigeminal Neuralgia

Zuo, Yuchao; Song, Dengpan; Hu, Yue; Zhao, Shengqi; Zhang, Mingchu; Wang, Meng; Guo, Fuyou

doi:10.1155/2022/7567630

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Finally, one must be careful to avoid intracerebral hemorrhage, during MVD with such high blood pressures [19]. Like our results of improved outcomes in patients with blood pressure spikes, Zuo et al reported that developing intra-operative HTN during BCR meant that the compression was successful, and further supported the use of continuous intra-operative blood pressure monitoring [20].…”

Section: Discussionsupporting

confidence: 70%

Intra-operative Hypertension as a Predictor of Surgical Outcomes in Microvascular Decompression Surgery for Trigeminal Neuralgia

Gupta,

Sabahi,

Santos

et al. 2024

Preprint

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Objective: The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes. Methods: We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery. Results: The mean age of the patients was 61.0±12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p=0.006). Conclusions: Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.

show abstract

Section: Discussionsupporting

confidence: 70%

Intra-operative Hypertension as a Predictor of Surgical Outcomes in Microvascular Decompression Surgery for Trigeminal Neuralgia

Gupta,

Sabahi,

Santos

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia

Gupta,

Sabahi,

Santos

et al. 2024

Acta Neurochir

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Purpose The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes. Methods We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery. Results The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006). Conclusions Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.

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Letter to the editor: A nomogram based on radiomics and clinical information to predict prognosis in percutaneous balloon compression for the treatment of trigeminal neuralgia

Iqbal,

Arsal,

Kumar

2024

Neurosurg Rev

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Continuous Intra-Arterial Blood Pressure Monitoring Improves the Efficiency of Percutaneous Balloon Compression of the Trigeminal Ganglion for Trigeminal Neuralgia

Cited by 3 publications

References 28 publications

Intra-operative Hypertension as a Predictor of Surgical Outcomes in Microvascular Decompression Surgery for Trigeminal Neuralgia

Intra-operative Hypertension as a Predictor of Surgical Outcomes in Microvascular Decompression Surgery for Trigeminal Neuralgia

Intra-operative hypertension as a predictor of surgical outcomes in microvascular decompression surgery for trigeminal neuralgia

Letter to the editor: A nomogram based on radiomics and clinical information to predict prognosis in percutaneous balloon compression for the treatment of trigeminal neuralgia

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