Turkish Neurosurgery 2016 , Vol 26 , Num 3
Trigeminal Cardiac Reflex Caused by Onyx Embolization of Intracranial Dural Arteriovenous Fistula
Jian WANG1,2, Huan-Cheng WU3, Wei-Wei WANG4, Hong-Sen ZHAO5, Ri-Na DAO5, Wei-Min LIU5, Dong-Zhe ZHOU5, Hui-Yu WANG5, Chao DU1
1China-Japan Union Hospital of Jilin University, The Second Department of Neurosurgery, Changchun City, JiLin Province, China.
2The Affiliated Hospital of Inner Mongolia National University, Neurosurgery Department, Tongliao, Inner Mongolia, China
3Encephalopathy Center of the Affiliated Hospital of Medical College of the Chinese People’s Armed Police Forces, Tianjin, China
4The Sixth People’s Hospital of Shenyang, Department of Infectious Diseases, Shenyang City, Liaoning Province, China
5The Affiliated Hospital of Inner Mongolia National University, Tongliao, Inner Mongolia, China
DOI : 10.5137/1019-5149.JTN.8008-13.1 Trigeminocardiac reflex (TCR) is a reflexive response of bradycardia, hypotension and gastric hypermotility which is observed upon mechanical stimulation in the distribution of the trigeminal nerve. Previous articles have described TCR during intracranial operations, ophthalmic surgery, microcompression of the trigeminal ganglion and radiofrequency lesioning of the trigeminal ganglion. TCR may occur during transarterial embolization of dural arteriovenous fistula (DAVF) with Onyx, leading to a significant decrease in heart rate under a standard anesthetic protocol. TCR may also occur due to chemical stimulus of dimethyl sulfoxide (DMSO) in transvenous Onyx embolization of dural cavernous sinus fistula. Slow rate of injection may give DMSO enough time to dissipate in the blood stream which is important for the prevention of toxicity. This report confirms that the reflex was blunted by the anticholinergic effects of atropine and there was no harm to patients if stopped immediately. Keywords : Trigeminal cardiac reflex, Onyx embolization, Intracranial dural arteriovenous fistula
Corresponding author : Chao Du, duchao0987@yahoo.com