The unseen risk: a systematic review of the incidence, management, and outcomes of the trigeminocardiac reflex in skull-base surgery.
Mohammadmahdi Sabahi, Mohammad Mirahmadi Eraghi, Omid Yousefi et al.
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In 30 seconds
This PRISMA-guided systematic review synthesized reports of intraoperative trigeminocardiac reflex (TCR) during skull-base and adjacent neurosurgical procedures. Twenty-eight studies described 329 patients; reported events were most often associated with microvascular decompression for trigeminal neuralgia (168; 51.1%). Immediate cessation or modification of the provoking maneuver was the main management approach, while medication or temporary pacing was used in selected severe or recurrent cases. No TCR-attributable deaths were reported. The authors note that heterogeneous definitions and incomplete denominators prevent reliable incidence estimates, and long-term functional outcomes are poorly documented.
Key findings
- Of 329 reported patients, 168 (51.1%) had TCR events during microvascular decompression for trigeminal neuralgia.
- Immediate cessation of the provoking maneuver was the cornerstone of management; escalation was needed only in selected severe or recurrent cases.
- No TCR-attributable mortality was reported, but long-term functional outcomes were limited and inconsistently documented.
- The 28 included studies had heterogeneous definitions and incomplete denominators, precluding reliable incidence estimates.
Why it matters
TCR can occur with trigeminal manipulation across several skull-base operative corridors, and the review highlights the importance of anticipating the response and recognizing its procedural triggers. Its synthesis describes an initial response and possible escalation options, while also showing that the evidence base is insufficient to establish reliable incidence or validated management recommendations.
What to keep in mind
The evidence comprised heterogeneous studies with incomplete denominators and largely limited, inconsistently reported long-term outcomes; retrospective designs precluded reliable incidence estimates and validated management recommendations.