Trigeminocardiac Reflex: Case Report and Literature Review of Intraoperative Asystole in Response to Manipulation of the Temporalis Muscle

The trigeminocardiac reflex is a sudden onset of bradycardia, hypotension, apnea, or gastric hypermotility in response to stimulation of the trigeminal nerve. A 60-year-old female underwent a left orbitozygomatic craniotomy to debulk a large skull base epidermoid cyst compressing the brainstem and c...

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Bibliographic Details
Published in:World neurosurgery 2019-02, Vol.122, p.424-427
Main Authors: Shakil, Husain, Wang, Alick P., Horth, Dillon A., Nair, Saeda S., Reddy, Kesava K.V.
Format: Article
Language:English
Subjects:
Anesthesia
Asystole
Bone Diseases - surgery
Epidermal Cyst - surgery
Female
Heart Arrest - etiology
Heart Arrest - physiopathology
Humans
Intraoperative Complications - etiology
Intraoperative Complications - physiopathology
Middle Aged
Oculocardiac reflex
Reflex, Trigeminocardiac - physiology
Skull Base
Temporal muscle
Temporal Muscle - physiopathology
Temporal Muscle - surgery
Trigeminal nerve
Trigeminocardiac reflex
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Summary:The trigeminocardiac reflex is a sudden onset of bradycardia, hypotension, apnea, or gastric hypermotility in response to stimulation of the trigeminal nerve. A 60-year-old female underwent a left orbitozygomatic craniotomy to debulk a large skull base epidermoid cyst compressing the brainstem and cranial nerves. Intraoperatively, retraction of the temporalis muscle consistently produced asystole. Cessation of retraction resulted in prompt return of sinus rhythm. Our report describes an unusual and extreme example of the trigeminocardiac reflex and explores possible etiologies. This is the third reported surgical case in which manipulation of the temporalis muscle alone was sufficient to elicit bradycardia and asystole, and the first such case within the context of neurosurgery. We emphasize the importance of surgical teams to be cognizant of such extreme examples of this reflex.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2018.10.186