Territorial and Extraterritorial Trigeminocardiac Reflex: A Review for the Neurosurgeon and a Type IV Reflex Vignette

Leon-Ariza, Daniel S.; León-Ariza, Juan S.; Gualdron, Mayra A; Bayona-Prieto, Jaime; León-Sarmiento, Fidias E.

doi:10.7759/cureus.11646

Cited by 4 publications

(4 citation statements)

References 47 publications

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“…TCR is further classified as territorial reflex and extraterritorial reflex. Territorial reflex which includes the TCR that occurs due to the stimulation of the opthalmic, maxillary, and mandibular division of the trigeminal nerve whereas extraterritorial reflex includes the reflex that occurs due to trigeminal nerves anatomical considerations [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Mhamunkar¹,

Kolari²,

Sequeira³

2022

Cureus

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Aim Trigeminocardiac reflex (TCR) manifests as typical hemodynamic perturbations including a sudden lowering of heart rate, mean arterial blood pressure (MABP), cardiac arrhythmias, and asystole. In literature, TCR has been seen during ocular surgeries, Lefort fractures, and craniofacial surgeries. However, the prevalence of the TCR has not been studied in zygomatic complex fractures . The aim of this study was to assess the prevalence of TCR in patients undergoing elevation with/without fixation of zygomatic complex fractures and isolated zygomatic arch fractures under local anesthesia and general anesthesia and to evaluate the prevalence of TCR in different age groups. Materials and methods The study comprised 26 participants diagnosed with zygomatic fractures indicated for surgical intervention. The aim of the study was to find the prevalence of TCR in patients undergoing surgical intervention (elevation of zygomatic complex fractures with/without fixation) under local anesthesia and general anesthesia. The heart rate and blood pressure were measured preoperatively, intraoperatively and postoperatively. Results Variation in heart rate was seen in patients undergoing surgery under local anesthesia and general anesthesia. However, a decrease in the heart rate i.e., bradycardia was noted intra-operatively in 75% of the patients operated under local anesthesia. The prevalence of TCR was noted intra-operatively in 23% of cases operated under general anesthesia. No significant changes were seen in the blood pressure of the patients. Conclusion In our study, we found out that the prevalence of TCR was more in the patients operated under local anesthesia i.e., 75% of patients. Out of the patients operated under general anesthesia i.e., 23% of patients showed TCR. No significant variations in blood pressure were observed in patients operated under local anesthesia or general anesthesia. The prevalence of TCR was found more often in the age group of 31-45 years in our study.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Mhamunkar¹,

Kolari²,

Sequeira³

2022

Cureus

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“…One of the most commonly proposed mechanisms of PEA arrest in neurosurgical procedures is the trigeminocardiac reflex (TCR). This neurogenic brainstem reflex is elicited by the stimulation of trigeminal afferents, leading to increased vagal tone with consequent bradycardia, hypotension, and gastric hypermotility [14,15]. Several case reports attribute periods of bradycardia and hypotension during neurosurgery to this phenomenon [12,[16][17][18][19][20][21][22].…”

Section: Case Reportmentioning

confidence: 99%

Intraoperative Pulseless Electrical Activity Cardiac Arrest during Intracranial Aneurysm Clipping: Case Report

Alaa¹,

Soghakhawari²,

Will³

et al. 2022

Neurosurg Cases Rev

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Background: Cardiac arrest is a rare intraoperative complication with few cases reported during neurosurgery. Proposed causes of PEA cardiac arrest in this setting include medications, irrigation, coronary vasospasm, and elicitation of the trigeminocardiac reflex.Case description: Here, we report the case of a 52-yearold man who suffered an intra-operative pulseless electrical activity (PEA) cardiac-arrest while undergoing elective clipping of a right MCA bifurcation aneurysm through pterional craniotomy.

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“…First, anterior exposure of the vertical region of the petrosal portion of the ipsilateral carotid artery is done in relation to the jugular bulb; second, the lateral segment of the basilar artery and anterior pons deeply located to the exposure are identified; third, the superior cerebellar artery, which passes below the CN IV and CN V is carefully manipulated. Hemodynamic aspects during brain manipulation should also be monitored aiming to prevent triggering a type I, II, or III trigeminocardiac reflex [ 12 , 13 ].…”

Section: Technical Reportmentioning

confidence: 99%

Combined Presigmoid-Subtemporal Approach in a Semi-Sitting Position for Petroclival Meningiomas: A Technical Report

Leon-Ariza¹,

Chaparro²,

Rosen³

et al. 2021

Cureus

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The removal of petroclival meningiomas (PMs) is considered a neurosurgical challenge due to the critical mobilization of key neurovascular structures. Limited knowledge about the benefits of operating on patients with PMs using the combined presigmoid-subtemporal approach (CPSA) in a semi-sitting position has precluded its generalizability. We report on ten patients with PMs operated in a semi-sitting position using CPSA. We remark that before the surgical approach was accomplished in our group of patients, the CPSA via semi-sitting position was conducted and standardized in six adult cadaveric heads. The neuroanatomic dissections made in cadavers allowed us to confidently use CPSA in our set of patients. There were no comorbidities, perioperative complications, or deaths associated with the surgical procedure. CPSA via a semi-sitting position can be considered a safe approach to remove PMs.

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Territorial and Extraterritorial Trigeminocardiac Reflex: A Review for the Neurosurgeon and a Type IV Reflex Vignette

Cited by 4 publications

References 47 publications

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Evaluation of Trigeminocardiac Reflex in Patients Undergoing Elevation of Zygomatic Fractures

Intraoperative Pulseless Electrical Activity Cardiac Arrest during Intracranial Aneurysm Clipping: Case Report

Combined Presigmoid-Subtemporal Approach in a Semi-Sitting Position for Petroclival Meningiomas: A Technical Report

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