Summary
Background. The trigemino-cardiac reflex (TCR) is a well-recognised phenomenon (first described in skull base surgery by the authors in 1999) that consists of bradycardia, arterial hypotension, apnoea, and gastric hypermobility. TCR occurs during skull base surgery at or around structures that are innervated by any sensory branch of the trigeminal nerve. Thus far, it has not been shown that peripheral stimulation of a trigeminal nerve can also cause this reflex.
Methods. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) and in heart rate (HR) of more than 20% compared to the baseline level and coinciding with the surgical manipulation at or around any branches of the trigeminal nerve. The anaesthesiological and the operative techniques that were used were standardised.
Clinical features. We describe here a 29-year-old woman with an endocrinological and imaging-proved micro-prolactinoma in which a TCR with a decrease in “arterial blood pressure” (130/70 mmHg up to a 100/40 mmHg) and an accompanying decrease of the HR (70 beats/min to 50 beats/min) was seen during preparation of the nasal mucosa for a transsphenoidal approach under general anaesthesia, lasting a few seconds until normalisation. After immediate application of atropine, the surgical procedure and the post-operative course was uneventful.
Management. We present the first report of peripheral stimulation of a sensory branch of the trigeminal nerve that leads to a TCR under general anaesthesia according to our strict criteria as defined in 1999. The present finding is therefore a key research development and gives substantial evidence that TCR is coincident enhancement of sympathetic and parasympathetic outflows to the heart, suggesting that genetic differences may affect the susceptibility for TCR.
References
F Anton P Peggel (1991) ArticleTitleCentral projections of trigeminal primary afferents innervating the nasal mucosa: a horseradish peroxidase study in the rat Neuroscience 41 617–628 Occurrence Handle1714553 Occurrence Handle10.1016/0306-4522(91)90354-Q Occurrence Handle1:STN:280:DyaK3MzjtlOrtg%3D%3D
VF Blanc JL Jacob J Milot L Cyrenne (1988) ArticleTitleThe oculorespiratory reflex revisited Can J Anaesth 35 466–472 Occurrence Handle10.1007/BF03026892
Daly De Burgh (1996) Peripheral arterial chemoreceptros and respiratory-cardiovascular integration Monographs of the physiological society NumberInSeries46 Oxford Medical Publications, Clarendon Press Oxford
A Gharabaghi A Koerbel A Samii J Kaminsky H von Goesseln M Tatagiba M Samii (2006) ArticleTitleThe impact of hypotension due to the trigeminocardiac reflex on auditory function in vestibular schwannoma surgery J Neurosurg 104 369–375 Occurrence Handle16572648 Occurrence Handle10.3171/jns.2006.104.3.369
JH Kaas (1990) Somatosensory system G Paxinos (Eds) The human central nervous system Academic Press San Diego 813–844
GT Moonie D Res D Elton (1964) ArticleTitleOculocardiac reflex during strabismus surgery Can Anaesth Surg J 11 621 Occurrence Handle1:STN:280:DyaF2M%2Fjs1Gqsw%3D%3D
E Nalivaiko CG De Pasquale WW Blessing (2003) ArticleTitleElectrocardiographic changes associated with the nasopharyngeal reflex in conscious rabbits: vago-sympathetic co-activation Auton Neurosci 105 101–104 Occurrence Handle12798206 Occurrence Handle10.1016/S1566-0702(03)00048-1 Occurrence Handle1:STN:280:DC%2BD3s3ntFGquw%3D%3D
H Prabhakar GP Rath R Arora (2007) ArticleTitleSudden cardiac standstill during skin flap elevation in a patient undergoing craniotomy J Neurosurg Anesthesiol 19 203–204 Occurrence Handle17592354 Occurrence Handle10.1097/ANA.0b013e31804e45e8
B Schaller (2007) ArticleTitleTrigeminocardiac reflex J Neurosurg 107 243 Occurrence Handle17639902 Occurrence Handle10.3171/JNS-07/07/0243
B Schaller D Weigel A Filis M Buchfelder (2007) ArticleTitleTrigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas: methodological of a prospective skull base study protocoll Brain Res 1149 69–75 Occurrence Handle17428450 Occurrence Handle10.1016/j.brainres.2005.08.060 Occurrence Handle1:CAS:528:DC%2BD2sXkvFGlsr4%3D
B Schaller (2005) ArticleTitleTrigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas Clin Neurol Neurosurg 107 468–474 Occurrence Handle16202819 Occurrence Handle10.1016/j.clineuro.2004.12.004
B Schaller (2005) ArticleTitleTrigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia J Neurosurg Anesthesiol 17 45–48 Occurrence Handle15632542
B Schaller (2004) ArticleTitleTrigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol 251 658–665 Occurrence Handle15311339 Occurrence Handle10.1007/s00415-004-0458-4 Occurrence Handle1:STN:280:DC%2BD2cvgs1GktA%3D%3D
B Schaller R Probst S Strebel O Gratzl (1999) ArticleTitleTrigeminocardiac reflex during surgery in the cerebellopontine angle J Neurosurg 90 215–220 Occurrence Handle9950491 Occurrence Handle1:STN:280:DyaK1M7jtl2qsg%3D%3D
J Schoenen G Grant (1990) Spinal cord: connections G Paxinos (Eds) The human central nervous system Academic Press San Diego 77–92
Z Tomori JG Widdicombe (1969) ArticleTitleMuscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract J Physiol Lond 200 25–49 Occurrence Handle5761951 Occurrence Handle1:STN:280:DyaF1M%2FnvVajuw%3D%3D
F Wallois JM Macron V Jounieaux B Duron (1991) ArticleTitleTrigeminal nasal receptors related to respiration and to various stimuli in cats Respir Physiol 85 111–125 Occurrence Handle1947448 Occurrence Handle10.1016/0034-5687(91)90010-G Occurrence Handle1:STN:280:DyaK38%2FltlGnsQ%3D%3D
Author information
Authors and Affiliations
Corresponding author
Additional information
Correspondence: Bernhard J. Schaller, MD, MA, DMSC, Department of Neurosurgery, University of Paris, Paris, France.
Rights and permissions
About this article
Cite this article
Schaller, B., Filis, A. & Buchfelder, M. Trigemino-cardiac reflex in humans initiated by peripheral stimulation during neurosurgical skull-base operations. Its first description. Acta Neurochir (Wien) 150, 715–718 (2008). https://doi.org/10.1007/s00701-008-1602-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-008-1602-1