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Trigeminocardiac reflex in neurosurgical practice: Report of two new cases.

Amirjamshidi A, Abbasioun K, Etezadi F, Ghasemi SB - Surg Neurol Int (2013)

Bottom Line: The second case was a 52-year-old female who underwent right pterional craniotomy for right clinoidal meningioma.Both cases could be managed successfully after on time detection of such life threatening complication and proper management.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sina Hospital, Emam Ave., Tehran, Iran.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Contrast enhanced T1W saggital MRI showing the same clinoidal meningioma
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Figure 3: Contrast enhanced T1W saggital MRI showing the same clinoidal meningioma

Mentions: A 52-year-old female was admitted because of decreased vision of about 8 months duration. She had no preoperative comorbidity. She was operated for a right clinoidal meningioma [Figure 2a and b]. General anesthesia was given in usual standard manner (using medications as in the previous case). A right standard pterional craniotomy was performed and tumor could be resected totally using micro-dissection technique. Hemostasis was achieved and bone flap fixed and skin closed in routine fashion. Bandage was applied while the patient was still intubated. Attaching the subgaleal drain to the suction bottle, her HR dropped from 86/min to 45/min and BP from 110/85 to 75/43 mmHg. The suction was disconnected and the patient was taken to the recovery room and extubated. All the vital signs were normal in the recovery room but when connecting the drain to the vacuum bag, HR and BP dropped again. Lastly, she could not tolerate the vacuum drain and we had to attach it to the bag without negative pressure. No extra medications were administered and drain was removed the day after operation. The postoperative course was otherwise uncomplicated.


Trigeminocardiac reflex in neurosurgical practice: Report of two new cases.

Amirjamshidi A, Abbasioun K, Etezadi F, Ghasemi SB - Surg Neurol Int (2013)

Contrast enhanced T1W saggital MRI showing the same clinoidal meningioma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815044&req=5

Figure 3: Contrast enhanced T1W saggital MRI showing the same clinoidal meningioma
Mentions: A 52-year-old female was admitted because of decreased vision of about 8 months duration. She had no preoperative comorbidity. She was operated for a right clinoidal meningioma [Figure 2a and b]. General anesthesia was given in usual standard manner (using medications as in the previous case). A right standard pterional craniotomy was performed and tumor could be resected totally using micro-dissection technique. Hemostasis was achieved and bone flap fixed and skin closed in routine fashion. Bandage was applied while the patient was still intubated. Attaching the subgaleal drain to the suction bottle, her HR dropped from 86/min to 45/min and BP from 110/85 to 75/43 mmHg. The suction was disconnected and the patient was taken to the recovery room and extubated. All the vital signs were normal in the recovery room but when connecting the drain to the vacuum bag, HR and BP dropped again. Lastly, she could not tolerate the vacuum drain and we had to attach it to the bag without negative pressure. No extra medications were administered and drain was removed the day after operation. The postoperative course was otherwise uncomplicated.

Bottom Line: The second case was a 52-year-old female who underwent right pterional craniotomy for right clinoidal meningioma.Both cases could be managed successfully after on time detection of such life threatening complication and proper management.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sina Hospital, Emam Ave., Tehran, Iran.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus