The Trigeminocardiac Reflex During the Anterior Transpetrosal Approach

Shibao, Shunsuke; Kenawy, Karam; Borghei-Razavi, Hamid; Yoshida, Kazunari

doi:10.1016/j.wneu.2017.07.086

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…The occurrence rate of TCR in our study was 74.2%, which is the first report, as far as we know, and it is much higher than in other skull-base surgeries previously reported [18, 19]. This phenomenon led us to assume that the efficacy of IN has a relationship with this nervous reflex.…”

Section: Discussionsupporting

confidence: 48%

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Wu¹,

Jiang²,

Niu³

et al. 2018

Stereotact Funct Neurosurg

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Background: Internal neurolysis (IN) is an effective surgical treatment for trigeminal neuralgia (TN) without neurovascular compression (NVC) or postoperative recurrence. However, the trigeminal nerve is directly manipulated during the procedure, and there is a high incidence of trigeminocardiac reflex (TCR). The aim of this study was to retrospectively analyze the outcome of IN and to explore its relationship with the occurrence of intraoperative TCR. Methods: Surgical and anesthesia records of 27 TN patients who underwent surgical treatment with IN at our department between March 2010 and September 2016 were retrospectively analyzed. Patients were divided into 2 groups on the basis of the occurrence of TCR during surgery, and clinical characteristics were compared. Pain intensity was assessed by the Barrow Neurological Institute (BNI) pain intensity score and BNI facial numbness score. Results: TCR was observed in 23 of 27 patients (85.2%); it manifested as obvious changes in mean arterial pressure and heart rate by at least 20% of the baseline values. Trigeminal nerve atrophy was found in 9 patients (33.3%). The immediate pain-free rate was 96.3%, and the “excellent” rate was 72.1% for follow-up, with a rate of numbness or hypesthesia of 97.1%. These outcomes were retrospectively compared between the TCR and non-TCR groups, and there was a nonsignificantly higher “excellent” rate in the TCR group than in the non-TCR group. Conclusions: This study demonstrated that IN is an effective treatment for TN without NVC and has a close relationship with intraoperative TCR. To our knowledge, this is the first research describing TCR during IN.

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Section: Discussionsupporting

confidence: 48%

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Wu¹,

Jiang²,

Niu³

et al. 2018

Stereotact Funct Neurosurg

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“…Understanding the mechanisms behind TCR, and the different outcomes it can cause is essential for the effective management of patients with certain medical conditions, such as trigeminal neuralgia. The appearance of TCR is widely reported in the literature [5,6,8], there are no reports on the different patterns of TCR observed during microvascular decompression surgery. Additionally, there is a paucity of literature on how developing TCR during surgery correlates with outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…There are several forms of TCR, including excitatory and inhibitory re exes. Classical TCR is de ned as hypotension, bradycardia, and loss of consciousness, during manipulation of the trigeminal nerve (MTN) or its branches and is observed in up to 18% of MVDs performed for TN [5]. The TCR can also be modulated by other re exes, such as the baroreceptor re ex [6].…”

Section: Introductionmentioning

confidence: 99%

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.

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“…There are several forms of TCR, including excitatory and inhibitory reflexes. Classical TCR is defined as hypotension, bradycardia, and loss of consciousness, during manipulation of the trigeminal nerve (MTN) or its branches and is observed in up to 18% of MVDs performed for TN [ 22 ]. The TCR can also be modulated by other reflexes, such as the baroreceptor reflex [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Understanding the mechanisms behind TCR, and the different outcomes it can cause is essential for the effective management of patients with certain medical conditions, such as trigeminal neuralgia. The appearance of TCR is widely reported in the literature [ 19 , 21 , 22 ], there are no reports on the different patterns of TCR observed during microvascular decompression surgery. Additionally, there is a paucity of literature on how developing TCR during surgery correlates with outcomes.…”

Section: Introductionmentioning

confidence: 99%

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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The Trigeminocardiac Reflex During the Anterior Transpetrosal Approach

Cited by 8 publications

References 18 publications

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

Outcome of Internal Neurolysis for Trigeminal Neuralgia without Neurovascular Compression and Its Relationship with Intraoperative Trigeminocardiac Reflex

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

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