The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

Gharabaghi, Alireza; Koerbel, Andrei; Samii, Amir; Kaminsky, Jan; Goesseln, Henning Von; Tatagiba, Marcos; Samii, Madjid

doi:10.3171/jns.2006.104.3.369

Cited by 75 publications

(76 citation statements)

References 47 publications

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“…From the clinical and laboratory investigations, it has been observed that nimodipine probably exerts a positive effect on the preservation of both the facial and the cochlear nerve function after VS surgery. Besides dose-dependent hypotension and its possibly intraoperative negative impact on postoperative auditory function, 5 nimodipine is a safe drug. Nimodipine's efficacy is apparently higher with regard to preservation of cochlear nerve function, especially in large tumors.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Scheller¹,

Wienke

Tatagiba

et al. 2016

JNS

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obJective A pilot study of prophylactic nimodipine and hydroxyethyl starch treatment showed a beneficial effect on facial and cochlear nerve preservation following vestibular schwannoma (VS) surgery. A prospective Phase III trial was undertaken to confirm these results. methods An open-label, 2-arm, randomized parallel group and multicenter Phase III trial with blinded expert review was performed and included 112 patients who underwent VS surgery between January 2010 and February 2013 at 7 departments of neurosurgery to investigate the efficacy and safety of the prophylaxis. The surgery was performed after the patients were randomly assigned to one of 2 groups using online randomization. The treatment group (n = 56) received parenteral nimodipine (1-2 mg/hr) and hydroxyethyl starch (hematocrit 30%-35%) from the day before surgery until the 7th postoperative day. The control group (n = 56) was not treated prophylactically. results Intent-to-treat analysis showed no statistically significant effects of the treatment on either preservation of facial nerve function (35 [ ]) (p = 0.530) 12 months after surgery. Since tumor sizes were significantly larger in the treatment group than in the control group, logistic regression analysis was required. The risk for deterioration of facial nerve function was adjusted nearly the same in both groups ], p = 0.91). In contrast, the risk for postoperative hearing loss was adjusted 2 times lower in the treatment group compared with the control group (OR 0.49 [95% CI 0.18-1.30], p = 0.15). Apart from dosedependent hypotension (p < 0.001), no clinically relevant adverse reactions were observed. coNclusioNs There were no statistically significant effects of the treatment. Despite the width of the confidence intervals, the odds ratios may suggest but do not prove a clinically relevant effect of the safe study medication on the preservation of cochlear nerve function after VS surgery. Further study is needed before prophylactic nimodipine can be recommended in VS surgery.Clinical trial registration no.: 2009-012088-32 (www.clinicaltrialsregister.eu)

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Section: Discussionmentioning

confidence: 99%

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Scheller¹,

Wienke

Tatagiba

et al. 2016

JNS

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“…Possible explanations include changes in the vascular supply of the auditory apparatus. It is hypothesized, that in schwannoma patients an already impaired vascular supply of the medullo-pontine brainstem region due to tumor compression may be critically exaggerated by the sudden TCR-induced hypotension (Gharabaghi, et al, 2006). Substantiation for this hypothesis derives from the observation of BAEP deteriorations after TCR that are thought to be of vascular origin as they occur minutes after the eliciting reflex (Acioly, et al, 2010).…”

Section: Outcome and Prognosismentioning

confidence: 99%

“…TCR occurred in 11% of the patients and hearing function could be preserved in 47% of all patients. However, only 11.1% of the patients in the TCR group vs. 51.4% in the non-TCR group 13 experienced a preserved auditory function postoperatively (Gharabaghi, et al, 2006). On the basis of these results, Acioly et al (Acioly, et al, 2010) studied if intraoperatively monitored deteriorations of the brain auditory evoked potentials (BAEP) during surgery of the cerebellopontine angle were directly connected to the occurrence of TCR.…”

Section: Outcome and Prognosismentioning

confidence: 99%

“…However, TCR does not only have significant impact on the intraoperative course but it has moreover been shown to influence the postoperative functional outcome. For example, occurence of intraoperative TCR is correlated with postoperative ipsilateral tinnitus and decline of auditory function (Gharabaghi, et al, 2006, Schaller, et al, 2008b. Gharabaghi et al (Gharabaghi, et al, 2006) have prospectively studied 100 patients scheduled for vestibular schwannoma surgery for their postoperative auditory function in correlation to the occurrence of TCR.…”

Section: Outcome and Prognosismentioning

confidence: 99%

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Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects

Abdulazim¹,

Stienen²,

Sadr-Eshkevari³

et al. 2012

Explicative Cases of Controversial Issues in Neurosurgery

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“…Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigemimal ganglion and radiofrequency lesioning of the trigeminal ganglion 3,6,[7][8][9][10][11][12][13][15][16][17][18][19][20][21][22][23][24] . TCR can be elicited by stimulating the afferent pathway not only from ciliary nerves but also from sensory branches of maxillary and mandibular divisions of the trigeminal nerve 15 .…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx

Jiang

et al. 2010

Interv Neuroradiol

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This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx. The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and transvenously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic protocol and by the same team. The TCR rate was subsequently calculated. Of the 45 patients, five showed evidence of TCR during transarterial Onyx injection and transvenous DMSO injection. Their HR fell 50% during intravascular procedures compared with levels immediately before the stimulus. However, blood pressure values were stable in all cases. The TCR rate for all patients was 11.1% (95% CI, 4 to 24%), 7.7% (95% CI, 2 to 21%) in patients treated intraarterially and 33.3% (4 to 78%) in patients treated intravenously. Once HR has fallen, intravenous atropine is indicated to block the depressor response and prevention further TCR episodes. TCR may occur due to chemical stimulus of DMSO and Onyx cast formation under a standardized anesthetic protocol and should be blunted by atropine.

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The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery

Cited by 75 publications

References 47 publications

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Prophylactic nimodipine treatment for cochlear and facial nerve preservation after vestibular schwannoma surgery: a randomized multicenter Phase III trial

Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects

The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx

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