Trigeminocardiac Reflex - 1st Edition - ISBN: 9780128004210, 9780128005934

Trigeminocardiac Reflex

1st Edition

Editors: Tumul Chowdhury Bernhard Schaller
eBook ISBN: 9780128005934
Hardcover ISBN: 9780128004210
Imprint: Academic Press
Published Date: 1st June 2015
Page Count: 256
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Trigeminocardiac Reflex is a comprehensive tutorial reference to the science, diagnosis, and possible treatment of the trigeminocardiac reflex (TCR) that is usually initiated when the trigeminal nerve is disturbed during intercranial surgery. Since first reported in 1999 by co-Editor Bernhard Schaller, the research focused on TCR is expanding. While its instance is rare, new discoveries are not only increasing diagnosis, but also providing more effective treatment protocols. This text is ideal as a reference for clinical and research neurologists, as a general introduction for clinical presentation, and as a foundation for new research.

Key Features

  • Represents the first tutorial reference focused on the Trigeminocardiac Reflex (TCR)
  • Content organized by two of the leading scientists in the area, Dr. Tumul Chowdhury (University of Manitoba) and Prof. Bernhard Schaller (University of Southampton)
  • Defines TCR, its onset, and possible treatments
  • Establishes a knowledge base for the future study of the TCR and treatment protocols


Professionals in Neurology, Neurosurgery, Neurophysiology, Neuroanesthesiology

Table of Contents

  • List of Contributors
  • Chapter 1. History of the Trigeminocardiac Reflex: An Odyssey
    • Conclusion
    • References
  • Chapter 2. The Trigeminal Nerve: Anatomical Pathways. Trigeminocardiac Reflex Trigger Points
    • Introduction
    • Anatomy of the Trigeminal Nerve
    • Topographical Anatomy of the Trigeminal Nerve Branches and the Occurrence of the TCR
    • Difference in the Incidence of the TCR During Neurosurgical Interventions: Anatomical Perspective. TCR Trigger Points
    • Conclusion
    • References
  • Chapter 3. The Trigeminal Nerve and the Autonomous Nerve System: Physiological Considerations
    • Introduction
    • Correlation Between the Trigeminal Nerve and the Sympathetic and Parasympathetic Nervous Systems
    • Central Mechanisms of Trigeminal Integration
    • Trigeminal Reflexes Mediated by the ANS
    • Cerebral Hemodynamic Changes
    • Conclusion
    • References
  • Chapter 4. The Trigeminal Nerve and the Heart
    • Introduction
    • Trigeminocardiac Reflex
    • Diving Reflex
    • Nasopharyngeal Reflex
    • Role of Sympathetic–Parasympathetic Interaction in Trigeminovagal Reflexes
    • Cardiac Responses to Trigeminal Reflexes
    • Conclusion
    • References
  • Chapter 5. Trigeminocardiac Reflex: Definition and Introduction
    • Introduction
    • TCR: A Unique Clinical Entity
    • Definition of the TCR
    • Cause–Effect Relationship
    • The Traditional Classification: TCRs Centrally and Peripherally Located with Respect to the Gasserian Ganglion
    • Extended Classification: Toward a Comprehensive Understanding of the TCR
    • The Role of HR in the Context of Classification
    • The Role of Blood Pressure in the Context of Classification
    • Chronic Versus Acute TCR
    • Discussion
    • Conclusion
    • References
  • Chapter 6. Brain Stem Mechanisms Responsible for the Trigeminocardiac Reflex
    • Physiology and Neurobiology of Trigeminocardiac Reflex
    • Conclusion
    • References
  • Chapter 7. The Oculocardiac Reflex
    • Introduction
    • Definition
    • Epidemiology
    • Mechanism
    • Reflex Pathway
    • Clinical Presentation
    • Predisposing and Precipitating Factors
    • Prevention
    • Management
    • Treatment
    • Anesthetics and the OCR
    • Conclusion
    • References
  • Chapter 8. The Trigeminocardiac Reflex in Neurosurgical Procedures
    • Introduction
    • Definition
    • Cerebellopontine Angle Surgery
    • Transsphenoidal Surgery
    • Microvascular Trigeminal Decompression (the Jannetta Procedure)
    • Aneurysmal Clipping
    • Other Skull-Base Tumors
    • Subdural Hematoma and Empyema
    • Hydrogen Peroxide
    • Coronary Spasm
    • Conclusions
    • References
  • Chapter 9. The Trigeminocardiac Reflex During Subarachnoid Hemorrhage and Neurovascular Surgery: Literature Review and Case Descriptions
    • Abbreviations
    • Introduction
    • Historical Perspective
    • Animal Models
    • Clinical Data on Cardiac Abnormalities After SAH
    • Description and Incidence of the TCR
    • The TCR in SAH and the Autonomic Storm Hypothesis
    • Clinical Data on TCR in SAH and Neurovascular Surgery
    • TCR During Neurovascular Interventions and Aneurysmal Clipping
    • The Anatomical Basis of Trigeminal Innervations of Large Cerebral Vessels
    • TCR Variability and Evidence of a Cause–Effect Relationship for Trigeminovascular Initiation of the TCR
    • Conclusion
    • References
  • Chapter 10. The Trigeminocardiac Reflex in Interventional Neuroradiology
    • Introduction
    • Pathophysiology
    • The TCR in Neurointerventional Procedures
    • Incidence and Treatment of the TCR in Neurointerventions
    • Conclusion
    • References
  • Chapter 11. The Trigeminocardiac Reflex and Craniomaxillofacial Surgery
    • Introduction
    • Historical Background
    • Definition
    • Classification
    • Current Concepts and Future Trends
    • The TCR in Craniomaxillofacial Surgery
    • The TCR in Dentistry
    • Mechanism
    • Predisposing Factors
    • Prevention and Management
    • Future Prospects
    • Conclusion
    • References
  • Chapter 12. The Trigeminocardiac Reflex in Neurological Disorders
    • Introduction
    • Future Prospects
    • Conclusion
    • References
  • Chapter 13. Anesthesia and the Trigeminocardiac Reflex
    • Introduction
    • Mechanism and Types of the TCR
    • Perioperative Variables
    • Other Situations Mimicking the TCR
    • Anesthetic Agents
    • Local Anesthetics
    • Anticholinergics
    • Narcotics
    • Inhalational Anesthetic Agents
    • Ketamine
    • Other Drugs
    • Cannabinoids
    • Tonabersat
    • Anesthetic Depth
    • Anesthetic Management of the TCR
    • Postoperative Functional Consequences of Intraoperative Occurrences of the TCR
    • Future Research
    • Conclusion
    • References
  • Chapter 14. Functional Consequences of the Trigeminocardiac Reflex
    • Introduction
    • Predicting the Occurrence of the TCR
    • The TCR as a Physiological Entity
    • Uneventful Outcome after the TCR
    • Management of the TCR
    • Functional Consequences Following the TCR
    • Conclusion
    • References
  • Chapter 15. The Trigeminocardiac Reflex: A Comparison with the Diving Reflex in Humans
    • Definitions
    • General Similarities
    • General Differences
    • The TCR, the DR, and the Autonomic Nervous System
    • The TCR and the DR as the Basis of Other Pathologies?
    • The TCR, the DR, and Phylogenesis
    • The TCR and the DR as Oxygen-Conserving Reflexes
    • Clinical Cases of the TCR and the DR
    • Conclusions
    • References
  • Chapter 16. The Oxygen-Conserving Potential of the Trigeminocardiac Reflex
    • Introduction
    • The DR as an oxygen-conserving reflex
    • Conclusion
    • References
  • Chapter 17. Management of the Trigeminocardiac Reflex
    • Introduction
    • Predisposing Factors
    • Treatment
    • Prevention
    • Conclusion
    • References
  • Chapter 18. The Future Role of the Trigeminocardiac Reflex
    • Introduction
    • Current Knowledge and Future Role
    • Conclusion
    • References
  • Index


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© Academic Press 2015
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About the Editor

Tumul Chowdhury

Affiliations and Expertise

Department of Anesthesiology and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada

Bernhard Schaller

Affiliations and Expertise

University of Southampton, Southampton, UK