2010
DOI: 10.1177/159101991001600107
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The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx

Abstract: This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx. The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and transvenously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic prot… Show more

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Cited by 66 publications
(55 citation statements)
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“…No microcatheter retention or other complications occurred during or after the procedure, such as embolic or hemorrhagic complications, hypotension, and bradycardia because of trigeminocardiac reflex. 5 All the follow-ups were performed by 2 neurologists from the neurology department of our clinical center (B.D., Y.W) as a part of usual clinical care.…”
Section: Resultsmentioning
confidence: 99%
“…No microcatheter retention or other complications occurred during or after the procedure, such as embolic or hemorrhagic complications, hypotension, and bradycardia because of trigeminocardiac reflex. 5 All the follow-ups were performed by 2 neurologists from the neurology department of our clinical center (B.D., Y.W) as a part of usual clinical care.…”
Section: Resultsmentioning
confidence: 99%
“…Stimulation of any of the sensory branches of the trigeminal nerves may result in bradycardia, hypotension, apnea, or gastric hypermotility. This constellation of signs, the trigeminocardiac reflex, has been observed during procedures that involve direct or indirect manipulation of the fifth cranial nerve, including craniofacial surgery, dental procedures, resection of cerebellopontine angle tumors, rhizotomy of the trigeminal ganglion or sensory root, endoscopic transphenoidal surgery, and endovascular embolization of intracranial dural arteriovenous fistulae [11][12][13][14][15][16]. Case reports describe sudden intra-operative cardiac arrest (asystole) attributable to the trigeminocardiac reflex [17,18].…”
Section: Discussionmentioning
confidence: 98%
“…16) Particularly, the incidence of trigemino-cardiac reflex, which may cause bradycardia or cardiac arrest, has been reported to be 11.1%. 21) This reflex has been reported frequently when Onyx was injected via the middle meningeal artery. [21][22][23] The frequent occurrence of cranial nerve palsy after TAE using Onyx may be explained by neurotoxicity of DMSO 21,22) and the facilitated permeation of Onyx to smaller vessels by the plug and push technique.…”
Section: Procedure-related Complication (Cranial Nerve Palsy)mentioning
confidence: 99%
“…21) This reflex has been reported frequently when Onyx was injected via the middle meningeal artery. [21][22][23] The frequent occurrence of cranial nerve palsy after TAE using Onyx may be explained by neurotoxicity of DMSO 21,22) and the facilitated permeation of Onyx to smaller vessels by the plug and push technique. 24) These complications of TAE using Onyx are considered to be avoided by placing the microcatheter as close to the shunt point as possible, paying attention to reflux, and monitoring the injection by a whole team consisting of not only the operator, but also assistants those are proficient in procedures using Onyx and versed in anatomy.…”
Section: Procedure-related Complication (Cranial Nerve Palsy)mentioning
confidence: 99%
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