Sudden Asystole due to Trigeminocardiac Reflex During Transsphenoidal Surgery for Pituitary Tumor

Cho, Jin Mo; Min, Kyungha; Kim, Eui Hyun; Oh, Min Chul; Kim, Sun Ho

doi:10.1016/j.wneu.2011.01.043

Cited by 17 publications

(20 citation statements)

References 29 publications

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“…Однако его развитие описано и при трансназальных нейрохирургических вмешательствах на гипофизе [14,15], и при различных вариантах краниомакси-лофациальных вмешательств [16]. Для ситуации тригемино-кардиального рефлекса характерно вне-запное развитие прогрессирующей брадикардии, вплоть до асистолии, на фоне хирургических мани-пуляций вблизи тройничного нерва или его ветвей.…”

Section: Discussionunclassified

Cardiac arrest after induction of anesthesia in neurosurgical patients

et al. 2015

Vopr. neirokhir.

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Section: Discussionunclassified

Cardiac arrest after induction of anesthesia in neurosurgical patients

et al. 2015

Vopr. neirokhir.

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“…Their series of cerebellopontine angle tumor operations had an 11% incidence of TCR upon manipulation of the trigeminal nerve near the brainstem [17]. More recently, severe TCR leading to asystole during transsphenoidal surgery of the pituitary has also been reported [7,18].…”

Section: Discussionmentioning

confidence: 99%

Trigeminocardiac Reflex after Direct Infusion of Chemotherapy into the Ophthalmic Artery for Retinoblastoma

Gaynor¹

2014

J Clin Exp Ophthalmol

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Introduction: Direct intra-ophthalmic artery infusion of chemotherapy has emerged as a front-line treatment modality for both early and advanced forms of retinoblastoma. The procedure has become common practice for neurointerventionalists at institutions with major ophthalmology centers. We present a case series of patients who manifest an autonomic reaction of acute hypoxemia, hypocapnia, hypotension, and bronchospasm consistent with trigeminocardiac reflex. We report our experience with this reaction, which is commonly seen during pediatric strabismus surgery but until now, rarely seen in the neuroangiography suite.

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“…[5131618212530] There are varieties of case reports in neurosurgical literature regarding the occurrence of TCR; during surgery within cerebellopontine angle (CPA),[25] around the brain stem[16] and the territory of the trigeminal nerve,[3] during transsphenoidal pituitary surgery,[4] while removing a falcine meningioma,[2] during draining of a subdural empyema,[26] when working around the eye and face especially in children,[5] during fixation of the stereotaxic frame,[27] with LeFort I osteotomy,[12] during embolization of intradural, dural or extradural highly vascular pathologies,[1314] while elevating the skin for craniotomy[17] or closing the skin at the end of the procedure,[6] and when connecting negative pressure to the subgaleal drain. [10]…”

Section: Discussionmentioning

confidence: 99%

“…The TCR was first described confidentially by Schellar et al . in 1999 and the validity of the case reports[2410111425] and researches performed in the domain of the physiology of TCR have added to our knowledge about the development of this phenomenon during brain surgeries. [202224] The main question would be how to predict and to prevent it?…”

Section: Introductionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

Amirjamshidi

Etezadi²,

Ghasemi³

2013

Surg Neurol Int

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Background:Systemic hypotension, cardiac dysrhythmia especially bradycardia, apnea, and gastric hypermotility occurring presumably after stimulation of any of the sensory branches of trigeminal nerve are coined as trigeminocardiac reflex (TCR). Neither enough is known about the predisposing factors in relation with the intraoperative occurrence of this life threatening reflex, nor about the exact pathophysiology of its brain stem pathway.Encountering two cases of bradycardia and hypotension during surgery encouraged the authors to: (1) report these two cases and review similar reports in the relevant literature, (2) discuss the suggested mechanisms for such an event, and (3) report the result of a prospective cohort of precisely checked cases in a sister article, to remind the younger neurosurgical community of a possible and bothering even mortal, but avoidable complication in their everyday practice.Case Description:The first case was a 71-year-old male who developed bradycardia and hypotension while packing his large sella tursica with autologous fat after removing a large nonfunctional pituitary adenoma transsphenoidally to prevent cerebrospinal fluid leakage. The changes in his vital signs were detected and controlled rapidly.The second case was a 52-year-old female who underwent right pterional craniotomy for right clinoidal meningioma. She developed severe bradycardia and hypotension after skin closure completed and just when the subgaleal drain was connected to the aspirating bag and negative pressure maintained in the subgaleal region.Both cases could be managed successfully after on time detection of such life threatening complication and proper management.Conclusion:We do not intend only to add two new cases of TCR occurring in the perioperative period in neurosurgical practice, but we wish to raise the question: (a) what could be the predisposing factors for development of such issue for better handling of the problem and (b) stress upon careful continuous mapping of the vital signs during surgery and even till very late after operation.

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Sudden Asystole due to Trigeminocardiac Reflex During Transsphenoidal Surgery for Pituitary Tumor

Cited by 17 publications

References 29 publications

Cardiac arrest after induction of anesthesia in neurosurgical patients

Cardiac arrest after induction of anesthesia in neurosurgical patients

Trigeminocardiac Reflex after Direct Infusion of Chemotherapy into the Ophthalmic Artery for Retinoblastoma

Trigeminocardiac reflex in neurosurgical practice: Report of two new cases

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