The trigeminocardiac reflex in Onyx embolisation of intracranial dural arteriovenous fistula

Abstract We investigated the incidence of the trigeminocardiac reflex (TCR) during ethylene vinyl alcohol copolymer (Onyx Liquid Embolic System, ev3 Neurovascular, Irvine, CA, USA) embolisation of intracranial dural arteriovenous fistulas (DAVFs) and evaluated the post-procedural recovery of these p...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2010-10, Vol.17 (10), p.1267-1270
Main Authors: Ong, C.K, Ong, M.T, Le, K, Power, M.A, Wang, L.L, Lam, D.V, Parkinson, R.J, Wenderoth, J.D
Format: Article
Language:English
Subjects:
Adult
Age
Bradycardia - drug therapy
Bradycardia - etiology
Cavernous Sinus - drug effects
Cavernous Sinus - pathology
Central Nervous System Vascular Malformations - complications
Central Nervous System Vascular Malformations - drug therapy
Cerebral Angiography
Dural arteriovenous fistula
Embolization, Therapeutic - methods
Female
Humans
Male
Middle Aged
Neurology
Onyx
Polyvinyls - therapeutic use
Reflex - drug effects
Retrospective Studies
Treatment Outcome
Trigeminal Nerve Diseases - complications
Trigeminal Nerve Diseases - drug therapy
Trigeminocardiac reflex
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Summary:Abstract We investigated the incidence of the trigeminocardiac reflex (TCR) during ethylene vinyl alcohol copolymer (Onyx Liquid Embolic System, ev3 Neurovascular, Irvine, CA, USA) embolisation of intracranial dural arteriovenous fistulas (DAVFs) and evaluated the post-procedural recovery of these patients. Between June 2006 and July 2009, 21 patients (11 females, 10 males) with a mean age of 61 years (range: 25–85 years) underwent 28 Onyx embolisations of intracranial DAVFs at our institution. The case histories of these patients were reviewed retrospectively. A TCR occurred in three (10.7%) of the embolisations, with bradycardia lower than 60 beats/minute and a drop in mean arterial blood pressure of 20% or more. The reflex was blunted promptly with intravenous atropine, and follow-up of these patients showed no complications that might have been directly related to it. The TCR may occur during Onyx embolisation of intracranial DAVFs. Recognition of this phenomenon allows for early detection and appropriate intraoperative management.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2010.01.041