Trigeminocardiac Reflex During Temporary Clipping in Aneurismal Surgery

The Trigeminal Nerve

“…49 After the Sylvian fissure had been opened, the carotid and optic cisterns were approached and a careful dissection was performed around the supraclinoid portion of the ICA. During the latter maneuver, the aneurysm ruptured, demanding temporary clipping of the parent vessel (the ICA).…”

Trigeminocardiac Reflex in Neurosurgery - Current Knowledge and Prospects

“…Most recently, Spiriev et al (Spiriev, et al, 2011a) have reported a patient who presented with subarachnoid hemorrhage (SAH) (Hunt and Hess 2, Fischer III) following the rupture of an aneurysm of the posterior communicating artery-internal carotid artery junction (PcomA-ICA). After the sylvian fissure had been opened, the carotid and optic cisterns were approached and a careful dissection around the supraclinoid portion of the ICA with target to ambient cistern was performed.…”

“…During the latter maneuver the aneurysm ruptured demanding temporary clipping of the parent vessel. After placing clips on the ICA, the patient experienced a 30 sec lasting sudden heart arrest (Spiriev, et al, 2011a). Taking into consideration that trigeminal terminals are found on all vessels of the circle of Willis and their distal branches throughout the adventitia and that the cell bodies of the supratentorial meningeal and cortical vessels lie within the ophthalmic division of the trigeminal ganglion it is possible that the observed response on the manipulation represents TCR (Simons and Ruskell, 1988).…”

“…Taking into consideration that trigeminal terminals are found on all vessels of the circle of Willis and their distal branches throughout the adventitia and that the cell bodies of the supratentorial meningeal and cortical vessels lie within the ophthalmic division of the trigeminal ganglion it is possible that the observed response on the manipulation represents TCR (Simons and Ruskell, 1988). Spiriev et al (Spiriev, et al, 2011a) reviewed the literature with reference to the occurrence of underlying TCR in aneurysm clipping procedures and found three further cases where cardiovascular responses are also most likely on the basis of TCR (Ganjoo, et al, 2010, Murakawa, et al, 2002, Takenaka, et al, 2006. Still, it has to be emphasized, that cardiac dysfunction including myocardial infarction is observed in up to 30% of SAH patients and has been discussed to result from excessive activity of the autonomous nervous system of unknown origin (Seule, et al, 2010).…”

“…In the past years, TCR has been reported to occur during several other neurosurgical procedures such as transsphenoidal surgery (Schaller, 2005a), Jannetta microvascular decompression (Schaller, 2005b), percutaneous radiofrequency thermocoagulation and percutaneous microcompression of the trigeminal ganglion (Meng, et al, 2008), neuroendovascular approaches in neurosurgery (Amiridze, et al, 2009, Lv, et al, www.intechopen.com Explicative Cases of Controversial Issues in Neurosurgery 4 2010, Lv, et al, 2007, Ong, et al, 2010, and during aneurysm clipping (Spiriev, et al, 2011a). As the TCR may have decisive impact on the surgical course as well as the postoperative functional outcome of neurosurgical patients with skull-base pathologies, the awareness of the TCR is essential for everyone involved in the treatment of those patients.…”