Intraoperative management of trigeminocardiac reflex in microvascular decompression of the trigeminal neuralgia
10.3969/j.issn.1672-5921.2017.09.002
- VernacularTitle:三叉神经痛显微血管减压术中三叉-心脏反射的处理
- Author:
Meng QI
;
Kunpeng FENG
;
Yang LIU
;
Mingchu LI
;
Hongchuan GUO
;
Ge CHEN
;
Jiantao LIANG
- Keywords:
Primary trigeminal neuralgia;
Microvascular decompression;
Trigeminocardiac reflex;
Anticholinergic agents;
Vasoactive agents;
Prognosis
- From:
Chinese Journal of Cerebrovascular Diseases
2017;14(9):454-458
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the treatment measures of having trigeminocardiac reflex (TCR) for the primary trigeminal neuralgia via microvascular decompression.Methods From January 2016 to December 2016,the clinical data and anesthesia records of 79 consecutive patients with primary trigeminal neuralgia admitted to the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University and treated the first craniotomy microvascular decompression were analyzed retrospectively.They were divided into a no TCR group (n=63) and a TCR group (n=16) according to the intraoperative anesthesia monitoring.The differences of baseline conditions,preoperative complications and pain involved the trigeminal nerve branches were compared between the two groups.The treatment measures and short-term prognosis of the patients with TCR during operation were summarized.Results (1) The proportion of hypertension in the TCR group was 31.2％ (n=5),it was higher than 7.9％ in the no TCR group (n=5).There was significant difference (χ2=6.273,P<0.05).(2) During the operation of microvascular decompression,16 patients in the TCR group had 19-time TCR.The baseline heart rate was 74±10/min before operation,and the heart rate decreased to 51±6/min at onset of TCR.The mean baseline arterial blood pressure was 102±13 mmHg,and the mean arterial blood pressure decreased to 74±8 mmHg at the onset of TCR.There was significant difference (P<0.05).(3) After the onset of TCR,the operation of was stopped,heart rate and the blood pressure recovered spontaneously (n=4).Fifteen patients were treated with medications,including using atropine (12 times,dose 0.2-0.5 mg) and ephedrine hydrochloride (3 times,dose 5-10 mg).Heart rate and blood pressure returned to the baseline level within 20 seconds or 20 seconds after administration of medications.There was no TCR-related cardiac complication or neurological deficit from after procedure to before discharge.Conclusions In microvascular decompression of primary trigeminal neuralgia,if TCR occurs,the selective use of anticholinergic agents or vasoactive agents is needed as early as possible.The risk factors for the occurrence of TCR need to be further verified.
