Recurrent trigeminocardiac reflex in percutaneous balloon compression for trigeminal neuralgia

Abstract

Rationale: Trigeminocardiac reflex (TCR) sometimes occurs during the percutaneous balloon compression (PBC) procedure to treat trigeminal neuralgia (TN), and it manifests as transient bradycardia or sinus arrest. However, recurrent intraoperative TCR cases are rarely reported. Meanwhile, the treatment for recurrent TCR is still unclear. Patient concerns: A 74-year-old male with a 2-year TN history could no longer tolerate the side effects of carbamazepine and came to seek PBC treatment. Diagnoses: Bradycardia or sinus arrest occurred repeatedly during the operation, and the heart rate (HR) rapidly returned to normal when the operation was suspended. The C-arm image showed the puncture needle entering the foramen ovale. Interventions: First, 0.5 mg atropine was administered twice, and then 1 mL of 2% lidocaine was injected locally at the puncture site. Finally, isoproterenol was continuously pumped and dynamically adjusted to maintain the HR above 90 bpm. Outcomes: The use of atropine and lidocaine did not prevent the recurrence of TCR. The use of isoproterenol to maintain the HR enabled the successful completion of the operation. The patient recovered quickly after the operation and was discharged 2 days later. No complaints of discomfort were reported during the sixth-month follow-up. Lessons: The elimination of intraoperative TCR may be difficult. Maintaining a high HR intraoperatively by continuous isoproterenol infusion is effective for preventing or mitigating the onset of TCR.

Gasserian ganglion radiofrequency thermoablation in a patient with aneurysm of the anterior communicating artery

“…Trigeminocardiac reflex can be found during percutaneous procedure to treat trigeminal neuralgia. It presents transient bradycardia or even sinus arrest [10,12]. Our patient did not show any bradycardia during the procedure.…”

Clinical Analysis of the Treatment of Primary Trigeminal Neuralgia by Percutaneous Balloon Compression

“…Third, the hospitalization time is short, and the patient can be discharged from hospital within 2–3 days after operation. Fourthly, the patient is well-tolerated, accepts the whole operation under general anesthesia, and the patient has less pain and discomfort during the operation ( 15 – 19 ).…”

The Effect of Trigeminal Ganglion Block on Trigeminocardiac Reflex in Elderly Patients with Trigeminal Neuralgia Undergoing Percutaneous Balloon Compression: A Randomized Controlled Study

“…Although PBC-induced TCR has been widely reported, 14 , 15 , 23 the pathophysiology of the TCR has not been well elucidated. Some studies suggested that the stimulation of trigeminal nerve could activate both the sympathetic and the parasympathetic nerve systems, which might result in dramatic changes in hemodynamics.…”

“… 14 However, the administration of anticholinergic agents sometimes can lead to cardiac arrhythmias or fail to terminate TCR. 15 , 16 Currently, the use of anticholinergic drugs for minimizing TCR-related bradycardia remains disputable. 17 Fortunately, nerve blocks were recommended as a simple and effective strategy to prevent TCR in some relevant studies.…”