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Yamada S, Yano Y, Fujita T, Taneda M. Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21198. [PMID: 35855412 PMCID: PMC9265173 DOI: 10.3171/case21198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Trigeminocardiac reflex (TCR) is a brainstem reflex caused by stimulation of the trigeminal nerve, which results in bradycardia, hypotension, and asystole. TCR can occur during any neurosurgical procedure. Initially, it is managed via the immediate removal of the stimulus from the trigeminal nerve. If asystole persists after intravenous atropine or glycopyrrolate, chest compression or transcutaneous cardiac pacing may be considered. The authors present the first case of TCR that was successfully managed with transcutaneous cardiac pacing.
OBSERVATIONS
A 51-year-old man presented with aneurysmal subarachnoid hemorrhage. Although he had no history of cardiac disease and there were no abnormal findings on electrocardiography, transient asystole due to TCR occurred during craniotomy. The patient’s heart rate spontaneously recovered after the immediate discontinuation of the procedure. The authors completed aneurysm clipping with transcutaneous cardiac pacing because intravenous atropine was not effective in preventing TCR. There were no complications associated with intraoperative asystole or transcutaneous cardiac pacing, and the patient was discharged without neurological deficits.
LESSONS
TCR can be appropriately managed with the immediate discontinuation of intraoperative procedures. Furthermore, transcutaneous cardiac pacing may be considered for persistent TCR with poor response to intravenous atropine or glycopyrrolate.
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Affiliation(s)
- Shuhei Yamada
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan; and
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshihiro Yano
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan; and
| | - Toshiaki Fujita
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan; and
| | - Mamoru Taneda
- Department of Neurosurgery, Hanwa Memorial Hospital, Osaka, Japan; and
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Burulday V, Bayar Muluk N, Kömürcü Erkmen SP, Akgül MH, Özdemir A. Important landmarks and distances for posterior fossa surgery measured by temporal MDCT. Neurosurg Rev 2020; 44:1533-1541. [PMID: 32596805 DOI: 10.1007/s10143-020-01342-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/27/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
In this retrospective study, we aimed to present important anatomical structures and distances for posterior fossa surgery by temporal multidetector computed tomography (MDCT). The temporal MDCT images of 317 adult patients (158 males and 159 females) were retrieved from the hospital's picture archiving and communication system (PACS). In the coronal temporal MDCT views, the cochlea-carotid canal and jugular bulb-mastoid bone outer surface were measured. In the axial MDCT views, the carotid canal-jugular bulb and carotid canal-posterior fossa distances were measured; the carotid canal and jugular bulb anterior-posterior (AP) and transverse dimensions were also measured. The bilateral cochlea-carotid canal, jugular bulb-mastoid bone outer surface, and right carotid canal-jugular bulb distances were significantly greater in the males than those in the females (p < 0.05). The carotid canal-posterior fossa distance was not different in both genders (p > 0.05). The carotid canal-jugular bulb and the carotid canal-posterior fossa distances were greater on the left side than those on the right side in both genders (p < 0.05). In males, the outer surface distance was greater on the left jugular bulb-mastoid bone than that on the right side of that bone (p < 0.05). The difference between the carotid canal AP dimensions was not significant between males and females (p > 0.05). However, the carotid canal transverse dimension, jugular bulb AP, and transverse dimensions were significantly greater in the males than those in the females, bilaterally (p < 0.05). In each gender separately, the carotid canal AP and transverse dimensions were greater on the left side and the jugular bulb AP and transverse dimensions were greater on the right side than those on the left side (p < 0.05). Positive correlations were found between the cochlea-carotid canal, the jugular bulb-mastoid bone outer surface, and the carotid canal-jugular bulb distances as well as between the jugular bulb-mastoid bone outer surface and the carotid canal-posterior fossa distances (p < 0.05). In older patients, the carotid canal-posterior fossa distances were shorter on the left side (p < 0.05). Vascular and neural localizations should be well understood in the operative area before applying the surgical approach in the posterior fossa. Computed tomography (CT) has a greater role in the evaluation of bone structures and vascular canals in this area.
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Affiliation(s)
- Veysel Burulday
- Radiology Clinics, Van Training and Research Hospital, Van, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey.
| | | | | | - Adnan Özdemir
- Radiology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Fiani B, Quadri SA, Farooqui M, D'Apuzzo M, Rosser RJ, Berman BW, Noel J, Xin XS, Badie B, Ramachandran A, Siddiqi J. A brainstem mass of Müllerian type Epithelial Origin without any primary cancer source. J Clin Neurosci 2018; 59:325-332. [PMID: 30337125 DOI: 10.1016/j.jocn.2018.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022]
Abstract
Brainstem tumors are rare, even rarer is a brainstem tumor containing tissues of an embryologic gynecologic origin. We report a very rare case of presence of a calcified heterogeneously contrast enhancing brainstem mass of Müllerian origin in a patient in a 38 year old female with no female genital tract cancer and past surgical history of ventriculoperitoneal (VP) shunt placement for congenital hydrocephalus. To our knowledge this is the very first and unusual case of a mass of gynecologic origin in the brainstem region especially in the setting of no history of gynecological tumor. The authors also reviewed the literature for all tumors reported for anterograde and retrograde dissemination of tumor cells through VP shunt. This case is a reaffirmation of the importance of brain tumor location and tissue diagnosis for the purpose of adjuvant treatment of neurosurgical lesions in the neurocritical care setting. It also highlights the role of catheters as potential routes of iatrogenic transmission not just in anterograde but also in a retrograde manner to the CNS, which is very unusual. This is the only second case to report retrograde flow of tumor cells from an extraneural source up the VP catheters. The authors suggest that intraperitoneal chemotherapy should be considered in the cases of known extraneural abdominal malignancies of high malignant potential with or without the presence of peritoneal infiltration in order to avoid dissemination through VP shunts.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Syed A Quadri
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA.
| | - Mudassir Farooqui
- Department of Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Massimo D'Apuzzo
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Robert J Rosser
- Department of Pathology, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Blake W Berman
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Jerry Noel
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Xin S Xin
- Division of Neurosurgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Behnam Badie
- Division of Neurosurgery, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Anirudh Ramachandran
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
| | - Javed Siddiqi
- Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA
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Meuwly C, Chowdhury T, Gelpi R, Erne P, Rosemann T, Schaller B. The clinical surrogate definition of the trigeminocardiac reflex: Development of an optimized model according to a PRISMA-compliant systematic review. Medicine (Baltimore) 2017; 96:e9033. [PMID: 29245296 PMCID: PMC5728911 DOI: 10.1097/md.0000000000009033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The trigeminocardiac reflex (TCR) is defined as sudden onset of parasympathetic dysrhythmias including hemodynamic irregularities, apnea, and gastric hypermotility during stimulation of sensory branches of the trigeminal nerve. Since the first description of the TCR 1999, there is an ongoing discussion about a more flexible than the existing clinical definition. Aim of this work was to create a clinical surrogate definition through a systematic review of the literature. METHODS In this meta-analysis study, literature about TCR occurrences was, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, systematically identified through various search engines including PubMed (Medline), Embase (Ovid SP), and ISI Web of Sciences databases from January 2005 to August 2015. TCR was defined as a drop of heart rate (HR) below 60 bpm or 20% to the baseline. We extracted detailed data about hemodynamic changes and searched for connections between arterial blood pressure (BP) and HR changes during such episodes. RESULTS Overall 45 studies harboring 57 patients were included in the study but only 32 patients showed sufficient data for final analyze. HR showed a nonlinear behavior with a "tipping point" phenomena that differs in variance from the central/peripheral (20-30% drop) to ganglion (40-49% drop). BP showed a linear behavior with a "central limit" phenomena not differing in variance in the whole subgroup (30-39% drop). An analyzation of the correlation between BP and HR showed a trend to a linear correlation. CONCLUSIONS We can show for the first time that HR is the dominant variable in the TCR and present a new surrogate definition model. This model and the role of BP must be better investigated in further studies.
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Affiliation(s)
- Cyrill Meuwly
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Tumul Chowdhury
- Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, Canada
| | - Ricardo Gelpi
- Department of Pathology, Institute of Cardiovascular Physiopathology, University of Buenos Aires, Buenos Aires, Argentina
| | - Paul Erne
- Department of Biomedicine, University Hospital Basel, Basel, Switzerland
| | - Thomas Rosemann
- Department of Primary Care, University of Zurich, Zurich, Switzerland
| | - Bernhard Schaller
- Department of Primary Care, University of Zurich, Zurich, Switzerland
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An Unusual Case of Asystole Occurring during Deep Brain Stimulation Surgery. Case Rep Neurol Med 2016; 2016:8930296. [PMID: 27217962 PMCID: PMC4863081 DOI: 10.1155/2016/8930296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious. A head CT demonstrated no acute findings. After deliberation, a decision was made to complete the procedure. Assuming the etiology of the episode was the Bezold-Jarisch reflex (BJR), appropriate accommodations were made. The procedure was completed uneventfully. Conclusion. The episode was consistent with a manifestation of the BJR. The patient had a history of neurocardiogenic syncope and a relatively low-volume state, factors prone to the BJR. Overall, lead implantation can still occur safely if preventive measures are employed.
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Lubnin AY, Israelyan LA, Shimanskiy VN, Odamanov DA. [Cardiac arrest after induction of anesthesia in neurosurgical patients]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:75-84. [PMID: 26529537 DOI: 10.17116/neiro201579375-84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper reports two clinical cases observed with a time lag of four years. In both cases, there were severe clinical symptoms of intracranial hypertension before the surgery. Prompt full-scale resuscitation was required in both cases due to asystole that developed immediately after induction of anesthesia and tracheal intubation. In one case, cardiac activity was successfully recovered by complex resuscitation with the emergency drainage of the cerebral ventricles. The possible causes of complications and preventive measures were discussed.
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Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - D A Odamanov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Cardiac emergencies in neurosurgical patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:751320. [PMID: 25692145 PMCID: PMC4321102 DOI: 10.1155/2015/751320] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/01/2014] [Accepted: 10/01/2014] [Indexed: 12/04/2022]
Abstract
Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery.
This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest.
Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events.
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Sandu N, Chowdhury T, Sadr-Eshkevari P, Filis A, Arasho B, Spiriev T, Schaller B. Trigeminocardiac reflex during cerebellopontine angle surgery: anatomical location as a new risk factor. FUTURE NEUROLOGY 2015. [DOI: 10.2217/fnl.14.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Aim: Trigeminocardicac reflex (TCR), a brainstem reflex, can be manifested in almost all types of surgery in the head and neck region. Patients & methods: Retrospective review of 125 patients operated on cerebellopontine angle (CPA) tumors according to strict inclusion/exclusion criteria. Results: A total of 14 out of 125 patients showed TCR during CPA tumor operation. In total, 29% of those patients presented with a meningioma located exclusively premeatal, but not retromeatal in the CPA. There was significant relationship between meningiomas subgroups and TCR (Barnard test; p < 0.05). Conclusion: Anatomical location may represent an important, but not yet described risk factor for the TCR having therefore an important role in the understanding of the TCR.
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Affiliation(s)
- Nora Sandu
- Department of Neurosurgery, University of Paris, Paris, France
| | - Tumul Chowdhury
- Department of Anesthesia, University of Manitoba, Winnipeg, Canada
| | | | - Andreas Filis
- Department of Neurosurgery, University of Erlangen, Erlangen, Germany
| | - Belachew Arasho
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
| | - Toma Spiriev
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
| | - Bernhard Schaller
- Department of Neurosurgery, University of Paris, Paris, France
- Department of Neurology, University of Addis Ababa, Addis Ababa, Ethiopia
- Department of Neurosurgery, Tokuda Hospital, Sofia, Bulgaria
- Department of Neuroanatomy, University of Pecs, Pecs, Hungary
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Chenin L, Capel C, N'Da H, Lefranc M, Peltier J. Unexpected ruptured aneurysm during posterior fossa surgery. Neurochirurgie 2014; 60:258-61. [PMID: 24856050 DOI: 10.1016/j.neuchi.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/13/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND IMPORTANCE Surgery is the recommended treatment for unique significant cerebellar metastasis, particularly in cases of hydrocephalus. Complications of posterior fossa surgery are associated with high risk of morbidity and mortality. We present a unique case of unexpected peroperative rupture of a cerebellar superior artery aneurysm during posterior fossa surgery. CLINICAL PRESENTATION During posterior cranial fossa surgery, severe arterial bleeding occurred in front of the medulla oblongata. Immediate postoperative computed tomographic (CT) angiography revealed a fusiform aneurysm from a distal branch of the left superior cerebellar artery. CONCLUSION To our knowledge, this is the first reported operative case of unexpected infratentorial ruptured aneurysm during posterior fossa surgery.
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Affiliation(s)
- L Chenin
- Department of Neurosurgery, Amiens Nord Hospital, Jules Verne University, France.
| | - C Capel
- Department of Neurosurgery, Amiens Nord Hospital, Jules Verne University, France
| | - H N'Da
- Department of Neurosurgery, Amiens Nord Hospital, Jules Verne University, France
| | - M Lefranc
- Department of Neurosurgery, Amiens Nord Hospital, Jules Verne University, France
| | - J Peltier
- Department of Neurosurgery, Amiens Nord Hospital, Jules Verne University, France
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Goyal K, Philip FA, Rath GP, Mahajan C, Sujatha M, Bharti SJ, Gupta N. Asystole during posterior fossa surgery: Report of two cases. Asian J Neurosurg 2012; 7:87-9. [PMID: 22870159 PMCID: PMC3410168 DOI: 10.4103/1793-5482.98654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Asystole during posterior fossa neurosurgical procedures is not uncommon. Various causes have been implicated, especially when surgical manipulation is carried out in the vicinity of the brain stem. The trigemino-cardiac reflex has been attributed as one of the causes. Here, we report two cases who suffered asystole during the resection of posterior fossa tumors. The vago-glossopharyngeal reflex and the direct stimulation of the brainstem were hypothesized as the causes of asytole. These episodes resolved spontaneously following withdrawal of the surgical stimulus emphasizing the importance of anticipation and vigilance during critical moments of tumor dissection during posterior fossa surgery.
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Affiliation(s)
- Keshav Goyal
- Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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