Trigeminocardiac reflex during surgery in the cerebellopontine angle

1999 ◽  
Vol 90 (2) ◽  
pp. 215-220 ◽  
Author(s):  
Bernhard Schaller ◽  
Rudolf Probst ◽  
Stephan Strebel ◽  
Otmar Gratzl
Keyword(s):  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Experimental Studies ◽  
Ocular Surgery ◽  
Content Type ◽  
Trigeminocardiac Reflex ◽  
Arterial Blood ◽  
Nerve System ◽  
Fine Print ◽  
Stimulation Of

Object. In different experimental studies authors have analyzed the autonomic responses elicited by the electrical, mechanical, or chemical stimulation of the trigeminal nerve system. The trigeminocardiac reflex (TCR) is a well-recognized phenomenon that consists of bradycardia, arterial hypotension, apnea, and gastric hypermotility. It occurs during ocular surgery and during other manipulations in and around the orbit. Thus far, it has not been shown that central stimulation of the trigeminal nerve can also cause this reflex.Methods. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) of more than 20% and bradycardia lower than 60 beats/minute. Pre-, intra-, and postoperative heart rate (HR) and MABP were reviewed retrospectively in 125 patients who underwent surgery for tumors of the cerebellopontine angle (CPA), and they were divided into two groups on the basis of the occurrence of the TCR during surgery. Of the 125 patients, 14 (11%) showed evidence of the TCR during dissection of the tumor near the trigeminal nerve at the brainstem. Their HRs fell 38% and their MABPs fell 48% during operative procedures as compared with preoperative levels. After cessation of manipulation, the HRs and the MABPs returned to preoperative levels. Risk factors for the occurrence of the TCR were compared with results from the literature.Conclusions. The authors' results show the possibility of occurrence of a TCR during manipulation of the central part of the trigeminal nerve when performing surgery in the CPA.

scholarly journals Trigeminocardiac reflex during surgery in the cerebellopontine angle

1998 ◽  
Vol 5 (3) ◽  
pp. E9 ◽  
Author(s):  
Bernhard Schall ◽  
Rudolf Probst ◽  
Stephan Strebel ◽  
Peter Fuhr ◽  
Otmar Gratzl
Keyword(s):  
Blood Pressure ◽  
Trigeminal Nerve ◽  
Cerebellopontine Angle ◽  
Experimental Studies ◽  
Ocular Surgery ◽  
Trigeminocardiac Reflex ◽  
Arterial Blood ◽  
Nerve System ◽  
Central Stimulation ◽  
Stimulation Of

In different experimental studies authors have analyzed the autonomic responses elicited by the electrical, mechanical, or chemical stimulation of the trigeminal nerve system. The trigeminocardiac reflex (TCR) is a well-recognized phenomenon that consists of bradycardia, arterial hypotension, apnea, and gastric hypermotility. It occurs during ocular surgery and during other manipulations in and around the orbit. Thus far, it has not been shown that central stimulation of the trigeminal nerve can also cause this reflex. The TCR was defined as clinical hypotension with a drop in mean arterial blood pressure (MABP) of more than 20% and bradycardia lower than 60 beats/minute. Pre-, intra-, and postoperative heart rate (HR) and blood pressure were reviewed retrospectively in 125 patients who underwent surgery for tumors of the cerebellopontine angle (CPA), and they were divided into a TCR group and a non-TCR group. Of the 125 patients, 14 (11%) showed evidence of TCR during dissection of the tumor near the trigeminal nerve at the brainstem. Their HR fell 38% and their MABP fell 48% during operative procedures as compared with preoperative levels. After cessation of manipulation, the HR and the MABP returned to preoperative levels. Risk factors for the occurrence of TCR were compared with results from the literature. The authors' results show the possibility of occurrence of a TCR during manipulation of the central part of the trigeminal nerve when performing surgery in the CPA.

Transcorneal stimulation of trigeminal nerve afferents to increase cerebral blood flow in rats with cerebral vasospasm: a noninvasive method to activate the trigeminovascular reflex

2002 ◽  
Vol 97 (5) ◽  
pp. 1179-1183 ◽  
Author(s):  
Basar Atalay ◽  
Hayrunnisa Bolay ◽  
Turgay Dalkara ◽  
Figen Soylemezoglu ◽  
Kamil Oge ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cerebral Vasospasm ◽  
Trigeminal Nerve ◽  
Nerve Endings ◽  
Noninvasive Method ◽  
Direct Stimulation ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

Object. The goal of this study was to investigate whether stimulation of trigeminal afferents in the cornea could enhance cerebral blood flow (CBF) in rats after they have been subjected to experimental subarachnoid hemorrhage (SAH). Cerebral vasospasm following SAH may compromise CBF and increase the risks of morbidity and mortality. Currently, there is no effective treatment for SAH-induced vasospasm. Direct stimulation of the trigeminal nerve has been shown to dilate constricted cerebral arteries after SAH; however, a noninvasive method to activate this nerve would be preferable for human applications. The authors hypothesized that stimulation of free nerve endings of trigeminal sensory fibers in the face might be as effective as direct stimulation of the trigeminal nerve. Methods. Autologous blood obtained from the tail artery was injected into the cisterna magna of 10 rats. Forty-eight and 96 hours later (five rats each) trigeminal afferents were stimulated selectively by applying transcorneal biphasic pulses (1 msec, 3 mA, and 30 Hz), and CBF enhancements were detected using laser Doppler flowmetry in the territory of the middle cerebral artery. Stimulation-induced changes in cerebrovascular parameters were compared with similar parameters in sham-operated controls (six rats). Development of vasospasm was histologically verified in every rat with SAH. Corneal stimulation caused an increase in CBF and blood pressure and a net decrease in cerebrovascular resistance. There were no significant differences between groups for these changes. Conclusions. Data from the present study demonstrate that transcorneal stimulation of trigeminal nerve endings induces vasodilation and a robust increase in CBF. The vasodilatory response of cerebral vessels to trigeminal activation is retained after SAH-induced vasospasm.

Trigeminal neuralgia associated with seizure and syncope

1984 ◽  
Vol 61 (3) ◽  
pp. 594-595 ◽  
Author(s):  
Wishwa N. Kapoor ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Mechanical Stimulation ◽  
Microvascular Decompression ◽  
Facial Pain ◽  
Loss Of Consciousness ◽  
Content Type ◽  
Vascular Decompression ◽  
Fine Print ◽  
Stimulation Of

✓ A patient with trigeminal neuralgia experienced a generalized seizure and a prolonged syncopal episode. He was found to be asystolic during the syncopal episode. There was no recurrence of loss of consciousness after implantation of a pacemaker. Mechanical stimulation of the trigeminal nerve during craniotomy for microvascular decompression of the trigeminal nerve resulted in bradycardia. Since vascular decompression of the trigeminal nerve, there has been no recurrent facial pain, and no further syncope, seizures, or bradycardia. Syncope and seizures have not been previously reported in association with trigeminal neuralgia, although they are well described with glossopharyngeal neuralgia.

Electrical stimulation of the trigeminal nerve root for the treatment of chronic facial pain

1995 ◽  
Vol 83 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Ronald F. Young
Keyword(s):  
Electrical Stimulation ◽  
Pain Intensity ◽  
Trigeminal Nerve ◽  
Nerve Root ◽  
Facial Pain ◽  
Content Type ◽  
Number Of Patients ◽  
Trigeminal Nerve Root ◽  
Fine Print ◽  
Stimulation Of

✓ Between March 1990 and December 1992, 23 patients with chronic intractable facial pain due to various forms of injury to the trigeminal nerve or nerve root underwent implantation of an electrical stimulating system to treat their pain. All patients had failed previous extensive pain treatment efforts. A monopolar platinum-iridium electrode was implanted on the trigeminal nerve root via percutaneous puncture of the foramen ovale. All patients experienced at least 50% reduction in pain intensity during a period of trial stimulation and underwent internalization of the electrode and connection to a completely implanted pulse generator. Independent assessment of the effect of stimulation was obtained by a specially trained nurse practitioner. Over a mean follow-up period of 24 months, six patients reported nearly complete relief of pain and six others reported at least a 50% reduction in pain intensity using a visual analog scale. Thus, 12 (52%) of the 23 patients achieved 50% or greater reduction in pain intensity. Although changes in the patterns of analgesic medication usage were few, six patients (26%) now experience a normal life style. Only one complication was seen, namely a dislocated electrode, which was easily replaced. Chronic electrical stimulation of the trigeminal nerve root appears to be an easy and safe technique for providing relief of chronic facial pain related to injury to the trigeminal nerve in a significant number of patients.

Clinical and electrophysiological studies on sensory conduction mediated by the accessory rootlets of the human trigeminal nerve

1975 ◽  
Vol 42 (5) ◽  
pp. 513-521 ◽  
Author(s):  
Adolfo Ley ◽  
Luis Montserrat ◽  
Fernando Bacci ◽  
Adolfo Ley
Keyword(s):  
Trigeminal Nerve ◽  
Blink Reflex ◽  
Content Type ◽  
Sensory Conduction ◽  
Before And After ◽  
Electrophysiological Studies ◽  
Sensory Fibers ◽  
Sensory Root ◽  
Fine Print ◽  
Stimulation Of

✓ The authors present records of potentials evoked in the roots of the trigeminal nerve by stimulation of its cutaneous branches. Records were made during nine operations for tic douloureux in which the main sensory root of the trigeminal nerve was totally sectioned under the microscope by the transcerebellar route. In every case, the accessory (aberrant) and motor roots were easily identified and spared. Records before and after total main sensory root division showed persistence of evoked potentials in the aberrant and motor fibers. Partial preservation of sensation and blink reflex in these cases reinforced the impression that there is somatic sensory conduction through true aberrant sensory fibers running between the motor and main sensory roots.

Referral of pain from dural stimulation in man

1971 ◽  
Vol 34 (5) ◽  
pp. 630-642 ◽  
Author(s):  
F. P. Wirth ◽  
J. M. Van Buren
Keyword(s):  
Trigeminal Nerve ◽  
Cervical Spinal Cord ◽  
Referred Pain ◽  
Referral Pattern ◽  
Central Projections ◽  
Content Type ◽  
Spinal Nerves ◽  
Implanted Electrodes ◽  
Fine Print ◽  
Stimulation Of

✓ Electrical stimulation of the dura was carried out in 25 patients using chronically implanted electrodes to determine areas of referred pain. Referred pain occurred over areas supplied by all divisions of the trigeminal nerve and the upper three cervical spinal nerves. No pattern of pain referral could be established on the basis of electrode positions determined from bone landmarks on the skull. It is suggested that these findings may be explained either by a greater overlap of the dural nerves than had been previously recognized, or by an overlap of the connections of the cervical nerves and the trigeminal nerve in the dorsal horn of the cervical spinal cord. Both of these mechanisms seem to be operative to some degree. Bilateral and contralateral pain was also elicited; whether this was due to stimulation of the bilateral termination of the dural nerves near the midline or of the bilateral central projections of these dural nerves is not clear. Contralateral referral of pain from dural points widely separated from the midline, however, suggests that some contralateral central projections do exist. The authors conclude that head pain of dural origin has limited clinical usefulness because of the lack of consistent specificity in its referral pattern.

The mechanism and effect of chronic electrical stimulation of the globus pallidus for treatment of Parkinson disease

2004 ◽  
Vol 100 (6) ◽  
pp. 997-1001 ◽  
Author(s):  
Mitsuhiro Ogura ◽  
Naoyuki Nakao ◽  
Ekini Nakai ◽  
Yuji Uematsu ◽  
Toru Itakura
Keyword(s):  
Electrical Stimulation ◽  
Parkinson Disease ◽  
Globus Pallidus ◽  
Rating Scale ◽  
Underlying Mechanism ◽  
Clinical Effects ◽  
Content Type ◽  
Chronic Electrical Stimulation ◽  
Fine Print ◽  
Stimulation Of

Object. Although chronic electrical stimulation of the globus pallidus (GP) has been shown to ameliorate motor disabilities in Parkinson disease (PD), the underlying mechanism remains to be clarified. In this study the authors explored the mechanism for the effects of deep brain stimulation of the GP by investigating the changes in neurotransmitter levels in the cerebrospinal fluid (CSF) during the stimulation. Methods. Thirty patients received chronic electrical stimulation of the GP internus (GPi). Clinical effects were assessed using the Unified PD Rating Scale (UPDRS) and the Hoehn and Yahr Staging Scale at 1 week before surgery and at 6 and 12 months after surgery. One day after surgery, CSF samples were collected through a ventricular tube before and 1 hour after GPi stimulation. The concentration of neurotransmitters such as γ-aminobutyric acid (GABA), noradrenaline, dopamine, and homovanillic acid (HVA) in the CSF was measured using high-performance liquid chromatography. The treatment was effective for tremors, rigidity, and drug-induced dyskinesia. The concentration of GABA in the CSF increased significantly during stimulation, although there were no significant changes in the level of noradrenaline, dopamine, and HVA. A comparison between an increased rate of GABA concentration and a lower UPDRS score 6 months postimplantation revealed that the increase in the GABA level correlated with the stimulation-induced clinical effects. Conclusions. Stimulation of the GPi substantially benefits patients with PD. The underlying mechanism of the treatment may involve activation of GABAergic afferents in the GP.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

The use of tissue culture in differentiation between angioblastic meningioma and hemangiopericytoma

1971 ◽  
Vol 34 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Jans Muller ◽  
John Mealey
Keyword(s):  
Tissue Culture ◽  
Tumor Cells ◽  
Cerebellopontine Angle ◽  
Content Type ◽  
Angioblastic Meningioma ◽  
Fine Print

✓ A solid, extrinsic hemangiopericytoma of the cerebellopontine angle was studied histologically and by means of tissue culture. The explanted tumor cells formed classic meningiomatous whorls indicative of the meningeal derivation of this neoplasm. Whorls were entirely absent in the histological preparations, however. The cases reported under the diagnosis of intracranial hemangiopericytoma and angioblastic meningioma have been reviewed; no valid histological distinction between these two types could be made.

Effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure

1987 ◽  
Vol 66 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Seigo Nagao ◽  
Tsukasa Nishiura ◽  
Hideyuki Kuyama ◽  
Masakazu Suga ◽  
Takenobu Murota
Keyword(s):  
Intracranial Pressure ◽  
Reticular Formation ◽  
Cerebral Blood Volume ◽  
Systemic Arterial Pressure ◽  
Brain Swelling ◽  
Dorsomedial Nucleus ◽  
Medullary Reticular Formation ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

✓ The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local cerebral blood volume (CBV) were continuously recorded in 32 cats. To assess the changes in the cerebral vasomotor tonus, the vasomotor index defined by the increase in ICP per unit change in BP was calculated. In 29 of the 32 animals, BP, ICP, and CBV increased simultaneously immediately after stimulation. The increase in ICP was not secondary to the increase in BP, because the vasomotor index during stimulation was significantly higher than the vasomotor index after administration of angiotensin II. The vasomotor index was high during stimulation of the area around the nucleus reticularis parvocellularis. In animals with the spinal cord transected at the C-2 vertebral level, ICP increased without a change in BP. These findings indicate that the areas stimulated in the medullary reticular formation play an important role in decreasing cerebral vasomotor tonus. This effect was not influenced by bilateral superior cervical ganglionectomy, indicating that there is an intrinsic neural pathway that regulates cerebral vasomotor tonus directly. In three animals, marked biphasic or progressive increases in ICP up to 100 mm Hg were evoked by stimulation. The reduction of cerebral vasomotor tonus and concomitant vasopressor response induced by stimulation of the medullary reticular formation may be one of the causes of acute brain swelling.

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