Usefulness of case reports to improve medical knowledge regarding trigemino-cardiac reflex in skull base surgery

Abstract

We describe the discovery of the trigemino-cardiac reflex by Schaller in 1999 and the continued improvement of the knowledge about the trigemino-cardiac reflex involved in neurosurgery, especially in skull base surgery, during the past several years. The achieved medical progress could be gained only by the practical experience described by different case reports and later case series that have been published in several principal scientific journals. Additionally, we explain the scientific as well as clinical importance of the communication of the case reports on TCR. Special reference has been given to the validity of the case reports for new phenomena in clinical medicine.

The Role of Acute Trigemino-Cardiac Reflex in Unusual, Non-Surgical Cases: A Review

“…If just one such observational case does not fit completely with the initial proposition, the hypothesis should be considered generally not valid and therefore should be revised or even rejected. This was not the case with our hypothesis of the existence of the TCR in non-surgical case reports and demonstrates that – besides the qualitative method of triangulation – the ongoing description of similar cases about a specific topic has importance not only for clinical practice but also for the scientific community (18, 19). However, after reviewing these non-surgical cases, the TCR phenomenon would certainly add the list of differential diagnoses in such situations.…”

Trigeminocardiac Reflex: Beyond a skull base Reflex

“…The TCR has developed from a phenomenon during skull base surgery to a perioperative factor influencing the outcome after skull base surgeries/interventions [2,13,14,25,[27][28][29]. This was already a milestone in neurosciences during the last 20 years.…”

“…The TCR is mainly investigated as an autonomous reflex during skull base interventions [3][4][5][6][7][8][9][10][11] and its role in predicting the surgical outcomes is also explored [12][13][14][15][16][17][18][19]. The role of the TCR is not only limited to certain neurosurgical conditions and recently, it is also linked with various other surgical conditions, sleep disorders, sudden infant death syndrome and other interventions [20,21].…”

Trigeminocardiac reflex: current trends

“…A further step in the TCR research would be to categorize these risk factors according to their consecutive molecular reaction. But here is still a gap between bench and bedside [20].…”

“…The role of various anatomical locations, different tumor pathologies, type of anesthetic (volatile vs total intravenous anesthetics) are some of the areas that are yet to be explored in context to TCR [20]. TCR might be a principal phenomenon in some neurological conditions including stroke, seizures, sleep bruxism, etc.…”