Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex

A Systematic Review

Daniel S. Leon-Ariza, Juan S. Leon-Ariza, Jasvinder Nangiana, Gabriel Vargas Grau, Fidias E. Leon-Sarmiento, Alfredo Quinones-Hinojosa

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Background: The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. Methods: A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. Results: A total of 575 patients were included in this study. TCR was found in 8.9% of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06; F = 0.3912809), covaried with age (P = 0.012; F = 9.302), and inversely correlated to each other (r = −0.27). Conclusions: TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.

Original languageEnglish (US)
Pages (from-to)4-10
Number of pages7
JournalWorld Neurosurgery
Volume117
DOIs
StatePublished - Sep 1 2018

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Trigeminocardiac Reflex
Arterial Pressure
Reflex
Anterior Cranial Fossa
Neurosurgical Procedures
Perioperative Period
Bradycardia
Heart Arrest
PubMed
MEDLINE
Heart Rate
Databases

Keywords

  • Asystole
  • Bradycardia
  • Cerebellopontine angle
  • Hypotension
  • Neurosurgery
  • Trigeminal nerve
  • Trigeminocardiac reflex

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex : A Systematic Review. / Leon-Ariza, Daniel S.; Leon-Ariza, Juan S.; Nangiana, Jasvinder; Vargas Grau, Gabriel; Leon-Sarmiento, Fidias E.; Quinones-Hinojosa, Alfredo.

In: World Neurosurgery, Vol. 117, 01.09.2018, p. 4-10.

Research output: Contribution to journalReview article

Leon-Ariza, Daniel S. ; Leon-Ariza, Juan S. ; Nangiana, Jasvinder ; Vargas Grau, Gabriel ; Leon-Sarmiento, Fidias E. ; Quinones-Hinojosa, Alfredo. / Evidences in Neurological Surgery and a Cutting Edge Classification of the Trigeminocardiac Reflex : A Systematic Review. In: World Neurosurgery. 2018 ; Vol. 117. pp. 4-10.
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abstract = "Background: The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. Methods: A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. Results: A total of 575 patients were included in this study. TCR was found in 8.9{\%} of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06; F = 0.3912809), covaried with age (P = 0.012; F = 9.302), and inversely correlated to each other (r = −0.27). Conclusions: TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.",
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AU - Vargas Grau, Gabriel

AU - Leon-Sarmiento, Fidias E.

AU - Quinones-Hinojosa, Alfredo

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AB - Background: The trigeminocardiac reflex (TCR) is characterized by bradycardia, decrease of mean arterial blood pressure, and sometimes, asystole during surgery. We critically reviewed TCR studies and devised a novel classification scheme for assessing the reflex. Methods: A comprehensive systematic literature review was performed using PubMed, MEDLINE, Web of Science, EMBASE, and Scielo databases. Eligible studies were extracted based on stringent inclusion and exclusion criteria. Statistical analyses were used to assess cardiovascular variables. TCR was classified according to morphophysiologic aspects involved with reflex elicitation. Results: A total of 575 patients were included in this study. TCR was found in 8.9% of patients. The reflex was more often triggered by interventions made within the anterior cranial fossa. The maxillary branch (type II in the new classification) was the most prevalent nerve branch found to trigger the TCR. Heart rate and mean arterial blood pressure were similarly altered (P = 0.06; F = 0.3912809), covaried with age (P = 0.012; F = 9.302), and inversely correlated to each other (r = −0.27). Conclusions: TCR is a critical cardiovascular phenomenon that must be quickly identified and efficiently classified and should trigger vigilance. Prompt therapeutic measures during neurosurgical procedures should be carefully addressed to avoid unwanted complications. Accurate categorization using the new classification scheme will help to improve understanding and guide the management of TCR in the perioperative period.

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