Trigeminal-cardiac reflex in neurosurgery: case report and literature update
DOI:
https://doi.org/10.11606/issn.1679-9836.v104i5e-234869Keywords:
Reflex trigeminocardiac, Trigeminal nerve, Vagus nerve, NeurosurgeryAbstract
The trigeminal-cardiac reflex (TCR), although a well-recognized and well-described phenomenon, is a relatively rare but potentially serious occurrence that should always be borne in mind during surgical procedures involving the skull, face and neck. We describe the case of a 45-year-old female patient who presented with episodes of bradycardia, hypotension and cardiac arrest during resection of a skull base meningioma. The incidence of RTC in neurosurgical procedures is variable, occurring mainly in skull base and cerebellopontine angle procedures, with mechanical stimulation being the most effective way of provoking it. There is usually reversal with withdrawal of the stimulus, but anticholinergics can be used in cases of persistent bradycardia and hypotension. Although TCR does not usually cause significant sequelae, there is a report of a fatal case due to coronary spasm. Because it is potentially serious, it is important for anesthesiologists and neurosurgeons to keep the possibility of this reflex in mind in order to avoid unfavorable outcomes.
Downloads
References
Chowdhury T, Schaller B. Chronic Trigemino-Cardiac Reflex: An Underestimated Truth. Front Neurol. 2017;8:22. Doi: 10.3389/fneur.2017.00022.
Recinos MA, Hsieh J, Mithaiwala H, Mucci JJ, Recinos PF. A rare appearance of the trigeminocardiac reflex during resection of posterior parasagittal meningioma. Surg Neurol Int. 2021;12:183. Doi: 10.25259/SNI_737_2020.
Singh G, Chowdhury T. Brain and heart connections: The trigeminocardiac reflex! J Neuroanaesthesiol Crit Care. 2017;4(2):71-7. Doi: 10.4103/jnacc.jnacc_24_17.
Schaller B, Chowdhury T. The trigeminocardiac reflex and implications for neuroanesthesia. J Neurosurg Anesthesiol. 2021;33(1):5-7. Doi: 10.1097/ANA.0000000000000735.
La Corte E, Gelmi CAE, Bertolini G, Ruggiero F, Younus I, Sturiale C, et al. Giuseppe Dagnini (1866-1928): Discoverer of the trigemino-cardiac reflex and practical implications in neurosurgery and other medical specialties. World Neurosurg. 2024;186:116-21. Doi: 10.1016/j.wneu.2024.03.086.
Zhao Y, Wang J, Li M, Ma T, Zhang X, Xu X, et al. The influence of trigeminocardiac reflex on postoperative cardiac adverse events in patients undergoing cerebellopontine angle tumor resections: A case-control study. World Neurosurg. 2023;172:e291-8. Doi: 10.1016/j.wneu.2023.01.010.
Hammad Y, Mootz A, Klein K, Zuniga J. Trigeminal nerve repair: Is the trigeminocardiac reflex a concern? J Oral Maxillofac Surg. 2021;79(11):2355-7. Doi: 10.1016/j.joms.2021.05.025.
Chowdhury T, Schaller B. The role of acute trigemino-cardiac reflex in unusual, non-surgical cases: A review. Front Neurol. 2016;7:186. Doi: 10.3389/fneur.2016.00186.
Marcenaro AG, Almeida SL. ECG essencial: eletrocardiograma na prática diária. 7ª ed. Rio de Janeiro: Artmed; 2013. 344 p.
Meuwly C, Chowdhury T, Gelpi RJ, Erne P, Rosemann T, Schaller B. The clinical surrogate definition of the trigeminocardiac reflex. Medicine (Baltimore). 2017;96(49):e9033. Doi: 10.1097/MD.0000000000009033.
Schaller B, Chowdhury T. The trigeminocardiac reflex and implications for neuroanesthesia. J Neurosurg Anesthesiol. 2020;33(1):5-7. Doi: 10.1097/ANA.0000000000000735.
Zhang H, Zhang M, Guo H, Liu M, He J, Li J. Risk factors associated with trigeminocardiac reflex in patients with trigeminal neuralgia during percutaneous balloon compression: A retrospective cohort study. Clin Neurol Neurosurg. 2023;231:107834. Doi:10.1016/j.clineuro.2023.107834.
Anto R, Jeyashanth R, Konduru V, Tirkey AJ. Trigeminocardiac reflex as a complication of excision of schwannoma of the trigeminal nerve: A rare clinical case report. Ann Maxillofac Surg. 2022;12(2):216-8. Doi: 10.4103/ams.ams_141_20.
Sharma P, Krishnaswami S, Shah K, Surve RM. Expanding the spectrum on brain-heart interactions in cerebellopontine angle surgeries. J Neurosci Rural Pract. 2024;15:384-6. Doi: 10.25259/JNRP_21_2024.
Long D, Chen K, Li Y, He P, Li X, Qin X, et al. Comparison of remimazolam and propofol for intravenous anesthesia on trigeminocardiac reflex in percutaneous balloon compression for trigeminal neuralgia: A randomized controlled trial. Drug Des Devel Ther. 2024;18:5225-37. Doi: 10.2147/DDDT.S473700.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Natalia Alini Haubenthal, Gisandra de Fátima Stangherlin, Heloísa Chiarini, Luiza de Gregori Dutra, Henrique Chiarini Batistella, Liliani Mathias Brum, Daniel Pascotto de Oliveira, Kelly de Oliveira Harada
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
