Advertisement

Trigemino-Cardiac Reflex and Trigeminal Neuralgia

  • Varun Jain
  • Gyaninder Pal Singh
Chapter

Abstract

Depressor response on heart due to stimulation of sensory branches of trigeminal nerve have been known since a long time. However, a formal interest in trigemino-cardiac reflex (TCR) grew after its introduction to neurosurgery in 1999 [1]. TCR is one of the strongest autonomic response and shows the complex relationship between brain and heart. There is no formal definition for the reflex; the widely accepted definition suggests TCR as a sudden fall in heart rate and mean blood pressure (BP) by 20% or more during surgical manipulation of structures innervated by the trigeminal nerve [2]. A definition to encompass other clinical manifestation of efferent vagal nerve suggests that trigemino-vagal reflex is an autonomic manifestation (e.g. change in breathing pattern and gastrointestinal motility) with or without change in heart rate or BP, coinciding with the stimulation of trigeminal nerve. Because bradycardia can be observed during operative procedures due to several reasons, a cause-effect relationship must be established to label a bradycardic episode as TCR. The cause–effect relationship can be established if TCR appears promptly on application of stimulus within 5 s (plausibility); stimulus cessation brings back the cardiovascular changes to baseline (reversibility); reapplication of similar stimulus leads to same hemodynamic changes (repetition); and trigeminal nerve block or use of anticholinergics or lower intensity stimulus does not lead to a repeat response (prevention) [2].

References

  1. 1.
    Schaller B, Probst R, Strebel S, Gratzl O. Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg. 1999;90:215–20.CrossRefGoogle Scholar
  2. 2.
    Meuwly C, Golanov E, Chowdhury T, Erne P, Schaller B. Trigeminal cardiac reflex: new thinking model about the definition based on a literature review. Medicine (Baltimore). 2015;94:e484.CrossRefGoogle Scholar
  3. 3.
    Kumada M, Dampney RA, Reis DJ. The trigeminal depressor response: a novel vasodepressor response originating from the trigeminal system. Brain Res. 1977;119:305–26.CrossRefGoogle Scholar
  4. 4.
    Abdulazim A, Stienen MN, Sadr-Eshkevari P, Prochnow N, Sandu N, Bohluli B, et al. Trigeminocardiac reflex in neurosurgery—current knowledge and prospects. In: Explicative Cases of Controversial Issues in Neurosurgery. InTech; 2012.Google Scholar
  5. 5.
    Sandu N, Spiriev T, Lemaitre F, Filis A, Schaller B, Trigemino-Cardiac-Reflex-Examination-Group (T.C.R.E.G.). New molecular knowledge towards the trigemino-cardiac reflex as a cerebral oxygen-conserving reflex. Sci World J. 2010;10:811–7.CrossRefGoogle Scholar
  6. 6.
    Schaller B, Cornelius JF, Prabhakar H, Koerbel A, Gnanalingham K, Sandu N, et al. The trigemino-cardiac reflex. J Neurosurg Anesthesiol. 2009;21:187–95.CrossRefGoogle Scholar
  7. 7.
    Rath GP, Sharma VB, Dube SK. Persistent premature atrial contraction as the sole presentation of trigeminocardiac reflex during radiofrequency thermocoagulation. J Neurosurg Anesthesiol. 2017;29:187–8.CrossRefGoogle Scholar
  8. 8.
    Panneton WM. The mammalian diving response: an enigmatic reflex to preserve life? Physiology (Bethesda). 2013;28:284–97.Google Scholar
  9. 9.
    Schaller B. Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia. J Neurosurg Anesthesiol. 2005;17:45–8.PubMedGoogle Scholar
  10. 10.
    Meng Q, Zhang W, Yang Y, Zhou M, Li X. Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia. J Neurosurg Anesthesiol. 2008;20:131–5.CrossRefGoogle Scholar
  11. 11.
    Schaller B, Sandu N, Filis A, Buchfelder M, Trigemino-Cardiac-Reflex-Examination-Group. Cardiovascular responses during percutaneous radiofrequency thermocoagulation therapy in primary trigeminal neuralgia: an explanation of the trigeminocardiac reflex? J Neurosurg Anesthesiol. 2008;20:270.CrossRefGoogle Scholar
  12. 12.
    Sweet WH, Poletti CE, Roberts JT. Dangerous rises in blood pressure upon heating of trigeminal rootlets; increased bleeding times in patients with trigeminal neuralgia. Neurosurgery. 1985;17:843–4.CrossRefGoogle Scholar
  13. 13.
    Chowdhury T, Cappellani RB, Schaller B, for Trigeminocardiac Reflex Examination Group (TCREG). Retrogasserian glycerol rhizolysis: first description of occurrence trigeminocardiac reflex. J Neurosurg Anesthesiol. 2014;26:86–7.CrossRefGoogle Scholar
  14. 14.
    Rath GP, Dash HH, Prabhakar H, Pandia MP. Cardiorespiratory arrest during trigeminal rhizolysis. Anaesthesia. 2007;62:971–2.CrossRefGoogle Scholar
  15. 15.
    Mullan S, Lichtor T. Percutaneous microcompression of the trigeminal ganglion for trigeminal neuralgia. J Neurosurg. 1983;59:1007–12.CrossRefGoogle Scholar
  16. 16.
    Chen CY, Luo CF, Hsu YC, Chen JF, Day YJ. Comparison of the effects of atropine and labetalol on trigeminocardiac reflex-induced hemodynamic alterations during percutaneous microballoon compression of the trigeminal ganglion. Acta Anaesthesiol Taiwanica. 2012;50:153–8.CrossRefGoogle Scholar
  17. 17.
    Gharabaghi A, Koerbel A, Samii A, Kaminsky J, von Goesseln H, Tatagiba M, et al. The impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery. J Neurosurg. 2006;104:369–75.CrossRefGoogle Scholar
  18. 18.
    Chowdhury T, Nöthen C, Filis A, Sandu N, Buchfelder M, Schaller B. Functional outcome changes in surgery for pituitary adenomas after intraoperative occurrence of the trigeminocardiac reflex: first description in a retrospective observational study. Medicine (Baltimore). 2015;94:e1463.CrossRefGoogle Scholar
  19. 19.
    Chowdhury T, Schaller B. Chronic trigemino-cardiac reflex: an underestimated truth. Front Neurol. 2017;8:22.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Alexander JP. Reflex disturbances of cardiac rhythm during ophthalmic surgery. Br J Ophthalmol. 1975;59:518–24.CrossRefGoogle Scholar
  21. 21.
    Schaller B. Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas. Clin Neurol Neurosurg. 2005;107:468–74.CrossRefGoogle Scholar
  22. 22.
    Puri AS, Thiex R, Zarzour H, Rahbar R, Orbach DB. Trigeminocardiac reflex in a child during pre-Onyx DMSO injection for juvenile nasopharyngeal angiofibroma embolization. A case report. Interv Neuroradiol. 2011;17:13–6.CrossRefGoogle Scholar
  23. 23.
    Meuwly C, Chowdhury T, Sandu N, Reck M, Erne P, Schaller B. Anesthetic influence on occurrence and treatment of the trigemino-cardiac reflex: a systematic literature review. Medicine (Baltimore). 2015;94:e807.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Varun Jain
    • 1
  • Gyaninder Pal Singh
    • 1
  1. 1.Department of Neuroanaesthesiology and Critical CareAll India Institute of Medical Sciences (AIIMS)New DelhiIndia

Personalised recommendations