Trigeminocardiac reflex during skull base surgery: mechanism and management
We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base. Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during su...
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| Veröffentlicht in: | Acta neurochirurgica 2005-07, Vol.147 (7), p.727-733 |
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| container_title | Acta neurochirurgica |
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| creator | Koerbel, A Gharabaghi, A Samii, A Gerganov, V von Gösseln, H Tatagiba, M Samii, M |
| description | We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base.
Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve.
Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon.
Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication. |
| doi_str_mv | 10.1007/s00701-005-0535-1 |
| format | Article |
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Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve.
Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon.
Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication.</description><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-005-0535-1</identifier><identifier>PMID: 15889318</identifier><language>eng</language><publisher>Austria: Springer Nature B.V</publisher><subject>Adult ; Aged ; Blood pressure ; Bradycardia - physiopathology ; Bradycardia - therapy ; Cavernous Sinus - surgery ; Craniotomy ; Electrocardiography ; Epidermal Cyst - surgery ; Female ; Heart - innervation ; Heart Rate - physiology ; Humans ; Hypotension - physiopathology ; Hypotension - therapy ; Intraoperative Complications - physiopathology ; Intraoperative Complications - therapy ; Male ; Meningeal Neoplasms - surgery ; Meningioma - surgery ; Middle Aged ; Monitoring, Intraoperative ; Neuroma, Acoustic - surgery ; Reflex, Oculocardiac - physiology ; Skull Base - innervation ; Skull Base - surgery ; Skull Base Neoplasms - physiopathology ; Skull Base Neoplasms - surgery ; Trigeminal Nerve - physiopathology</subject><ispartof>Acta neurochirurgica, 2005-07, Vol.147 (7), p.727-733</ispartof><rights>Springer-Verlag/Wien 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-43623a53b43cb56f9968ed78e6485438f1de7ae7656cfbfce540a83ba3329d233</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15889318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koerbel, A</creatorcontrib><creatorcontrib>Gharabaghi, A</creatorcontrib><creatorcontrib>Samii, A</creatorcontrib><creatorcontrib>Gerganov, V</creatorcontrib><creatorcontrib>von Gösseln, H</creatorcontrib><creatorcontrib>Tatagiba, M</creatorcontrib><creatorcontrib>Samii, M</creatorcontrib><title>Trigeminocardiac reflex during skull base surgery: mechanism and management</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir (Wien)</addtitle><description>We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base.
Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve.
Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon.
Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication.</description><subject>Adult</subject><subject>Aged</subject><subject>Blood pressure</subject><subject>Bradycardia - physiopathology</subject><subject>Bradycardia - therapy</subject><subject>Cavernous Sinus - surgery</subject><subject>Craniotomy</subject><subject>Electrocardiography</subject><subject>Epidermal Cyst - surgery</subject><subject>Female</subject><subject>Heart - innervation</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Hypotension - physiopathology</subject><subject>Hypotension - therapy</subject><subject>Intraoperative Complications - physiopathology</subject><subject>Intraoperative Complications - therapy</subject><subject>Male</subject><subject>Meningeal Neoplasms - surgery</subject><subject>Meningioma - surgery</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative</subject><subject>Neuroma, Acoustic - surgery</subject><subject>Reflex, Oculocardiac - physiology</subject><subject>Skull Base - innervation</subject><subject>Skull Base - surgery</subject><subject>Skull Base Neoplasms - physiopathology</subject><subject>Skull Base Neoplasms - surgery</subject><subject>Trigeminal Nerve - physiopathology</subject><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kU1LAzEQhoMotlZ_gBdZPOhpNdlksok3KX5hwUs9h2x2tm7dj5p0wf57U1oQPHiZJMwzL2QeQs4ZvWGU5rchFspSSiGlwCFlB2RMtcjSWOhhvNPYlZlUI3ISwjK-slzwYzJioJTmTI3J69zXC2zrrnfWl7V1iceqwe-kHHzdLZLwOTRNUtiASRj8Av3mLmnRfdiuDm1iuzJpbWdjAnbrU3JU2Sbg2f6ckPfHh_n0OZ29Pb1M72ep46DWqeAy4xZ4IbgrQFZaS4VlrlAKBYKripWYW8wlSFcVlUMQ1CpeWM4zXWacT8j1Lnfl-68Bw9q0dXDYNLbDfggmBwEgmFCRvPqXlLkGgCyL4OUfcNkPvou_2KZprTToCLEd5HwfQtyTWfm6tX5jGDVbIWYnxEQhZivEsDhzsQ8eihbL34m9Af4DJBeFWw</recordid><startdate>200507</startdate><enddate>200507</enddate><creator>Koerbel, A</creator><creator>Gharabaghi, A</creator><creator>Samii, A</creator><creator>Gerganov, V</creator><creator>von Gösseln, H</creator><creator>Tatagiba, M</creator><creator>Samii, M</creator><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200507</creationdate><title>Trigeminocardiac reflex during skull base surgery: mechanism and management</title><author>Koerbel, A ; Gharabaghi, A ; Samii, A ; Gerganov, V ; von Gösseln, H ; Tatagiba, M ; Samii, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-43623a53b43cb56f9968ed78e6485438f1de7ae7656cfbfce540a83ba3329d233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Blood pressure</topic><topic>Bradycardia - physiopathology</topic><topic>Bradycardia - therapy</topic><topic>Cavernous Sinus - surgery</topic><topic>Craniotomy</topic><topic>Electrocardiography</topic><topic>Epidermal Cyst - surgery</topic><topic>Female</topic><topic>Heart - innervation</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Hypotension - physiopathology</topic><topic>Hypotension - therapy</topic><topic>Intraoperative Complications - physiopathology</topic><topic>Intraoperative Complications - therapy</topic><topic>Male</topic><topic>Meningeal Neoplasms - surgery</topic><topic>Meningioma - surgery</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative</topic><topic>Neuroma, Acoustic - surgery</topic><topic>Reflex, Oculocardiac - physiology</topic><topic>Skull Base - innervation</topic><topic>Skull Base - surgery</topic><topic>Skull Base Neoplasms - physiopathology</topic><topic>Skull Base Neoplasms - surgery</topic><topic>Trigeminal Nerve - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koerbel, A</creatorcontrib><creatorcontrib>Gharabaghi, A</creatorcontrib><creatorcontrib>Samii, A</creatorcontrib><creatorcontrib>Gerganov, V</creatorcontrib><creatorcontrib>von Gösseln, H</creatorcontrib><creatorcontrib>Tatagiba, M</creatorcontrib><creatorcontrib>Samii, M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koerbel, A</au><au>Gharabaghi, A</au><au>Samii, A</au><au>Gerganov, V</au><au>von Gösseln, H</au><au>Tatagiba, M</au><au>Samii, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trigeminocardiac reflex during skull base surgery: mechanism and management</atitle><jtitle>Acta neurochirurgica</jtitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2005-07</date><risdate>2005</risdate><volume>147</volume><issue>7</issue><spage>727</spage><epage>733</epage><pages>727-733</pages><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base.
Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve.
Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon.
Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medication.</abstract><cop>Austria</cop><pub>Springer Nature B.V</pub><pmid>15889318</pmid><doi>10.1007/s00701-005-0535-1</doi><tpages>7</tpages></addata></record> |
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| ispartof | Acta neurochirurgica, 2005-07, Vol.147 (7), p.727-733 |
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| subjects | Adult Aged Blood pressure Bradycardia - physiopathology Bradycardia - therapy Cavernous Sinus - surgery Craniotomy Electrocardiography Epidermal Cyst - surgery Female Heart - innervation Heart Rate - physiology Humans Hypotension - physiopathology Hypotension - therapy Intraoperative Complications - physiopathology Intraoperative Complications - therapy Male Meningeal Neoplasms - surgery Meningioma - surgery Middle Aged Monitoring, Intraoperative Neuroma, Acoustic - surgery Reflex, Oculocardiac - physiology Skull Base - innervation Skull Base - surgery Skull Base Neoplasms - physiopathology Skull Base Neoplasms - surgery Trigeminal Nerve - physiopathology |
| title | Trigeminocardiac reflex during skull base surgery: mechanism and management |
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