Cardiac Arrest during Temporary Clipping for Ruptured Internal Carotid Artery Aneurysm: A Case Report

Area of Science:

• Neurosurgery
• Cardiology
• Neurology

Background:

• The trigeminal cardiac reflex (TCR) is a known phenomenon where mechanical stimulation of the trigeminal nerve can induce cardiovascular changes like bradycardia and hypotension.
• Surgical interventions involving the craniofacial region, skull base, or dental procedures carry a risk of triggering TCR.

Observation:

• A rare case of sinus arrest occurred during intracranial carotid artery clipping for a ruptured aneurysm.
• The patient, a man in his 30s, experienced cardiac arrest twice during the procedure.
• Post-operative cardiac evaluations, including ultrasound and Holter monitoring, revealed no abnormalities.

Findings:

• The cardiac arrest in this case is strongly suspected to be triggered by the stimulation of the trigeminal nerve branches associated with the internal carotid artery.
• The recurrent nature and specific anatomical context suggest TCR as the likely cause of the observed cardiac arrest.

Implications:

• Neurosurgeons should consider the potential for TCR-induced cardiac arrest during internal carotid artery clipping, even in the absence of predisposing factors.
• Further research is needed to elucidate the exact mechanisms and predisposing factors for TCR-triggered arrhythmias during neurovascular surgery.