Trigeminocardiac reflex during supratentorial craniotomy for intraventricular meningioma: illustrative case

Trigeminocardiac reflex (TCR) is a vagal reflex produced by trigeminal nerve stimulation that causes bradycardia, hypotension, and, occasionally, cardiac arrest. TCR usually occurs during surgical manipulation of the posterior fossa. In this report, the authors describe an extremely rare case of TCR that developed when a burr hole was drilled on the temporal bone during surgery for an intraventricular meningioma.

The patient was referred to the authors' department after brain imaging revealed a mass lesion in the right trigone of the lateral ventricle. The surgery, which was performed using a transcortical approach via the right temporal lobe, was conducted under general anesthesia with the patient in the supine lateral position. During craniotomy, the patient experienced 17 seconds of cardiac arrest during the drilling of a burr hole in the temporal bone. TCR could not be diagnosed at that time because it occurred during the manipulation of supratentorial craniotomy with a burr hole. The operation was aborted immediately. The second surgery was performed with the patient in the lateral position, and total removal of the tumor was achieved without causing TCR.

In this report, the authors describe a rare TCR caused by supratentorial manipulation. https://thejns.org/doi/10.3171/CASE257.