Neurosurgical management of carotid sinus hypersensitivity. Report of three cases

Carotid sinus hypersensitivity (CSH) can cause severe bradycardia, hypotension, asystole, and cardiac arrest. Three patients with the combined (mixed) cardioinhibitory and vasodepressor form of CSH were studied with intensive cardiovascular monitoring. After medical management failed, the patients were successfully treated by transection of the glossopharyngeal nerve and upper rootlets of the vagus nerve at their exit from the brain stem. Methods of diagnosis of CSH, and the benefits and limitations of medical and surgical therapies are discussed.