2025 Poster Presentations
P066: SKULL-BASE SURGERY AND THE TRIGEMINOCARDIAC REFLEX: A SYSTEMATIC REVIEW
Mohammadmahdi Sabahi, MD, MPH1; Omid Yousefi, MD2; Mohammad Mirahmadi Eraghi, MDHMBA3; AmirAli Rastegar Kazerooni, MD, MPH2; Sara Mostafavi, MD, MPH2; Badih Adada, MD1; Hamid Borghei-Razavi, MD1; 1Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida; 2Department of Neurological Surgery, Shiraz University of Medical Sciences, Shiraz, Iran; 3Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Objective: The trigeminocardiac reflex (TCR) is a significant but often under-recognized phenomenon encountered during skull-base surgery. This systematic review aims to elucidate the incidence, management, and surgical outcomes associated with TCR in skull-base procedures.
Methods: A systematic review was conducted according to the PRISMA guideline using PubMed, Scopus, Web of Science, Embase, and Cochrane Library to identify studies reporting on TCR in skull-base surgery. The Joanna Briggs Institute checklist was used to assess risk of bias.
Results: 17 articles were included for qualitative analysis. These comprised 8 case reports, 3 case series, and 6 cross-sectional studies, collectively covering 140 cases of TCR. The mean age of patients was 55.42 years, with a female predominance (57%). Fourteen patients had a history of cardiac disease, and 58 had hypertension. Among the 139 patients with available data, 8 had trigeminal neuralgia. For the remaining patients, the TCR occurred due to surgeries for various tumor pathologies, including schwannomas, pituitary adenomas, and meningiomas, located in regions such as the infratemporal fossa and posterior falx. Surgical techniques employed included infratemporal fossa type B, anterior petrosal approaches, transsphenoidal, and transcranial methods. Cardiac events such as bradycardia were observed in 12 cases, with 6 cases experiencing asystole. Other ECG changes were documented. Limited data indicated blood pressure changes lasting about 2 minutes and heart rate changes ranging from 10 seconds to 2 minutes. Outcomes were generally favorable, with 11 patients having uneventful recoveries, though one required a second surgery due to persistent symptoms, and another experienced transient muscle weakness that improved with treatment. Follow-up data were sparse, with some studies reporting normal conditions post-surgery and others noting tumor recurrence.
Conclusion: The trigeminocardiac reflex presents a significant intraoperative challenge in skull-base surgery. Understanding its pathophysiology, incidence, and management strategies is crucial for improving surgical outcomes. This systematic review highlights the need for increased awareness and better preventive measures to mitigate the risks associated with TCR in skull-base procedures.