Sharma Prachi, Krishnaswami Sharath, Shah Keyur, Surve Rohini M
Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Neuroanaesthesia and Neurocritical Care, Paras Hospital, Gurugram, Haryana, India.
J Neurosci Rural Pract. 2024 Apr-Jun;15(2):384-386. doi: 10.25259/JNRP_21_2024. Epub 2024 Mar 21.
Lesions at the cerebellopontine angle (CP angle) are associated with various brain-heart interactions, which can include those from stimulation of the fifth cranial nerve along the scalp incision in a retrosigmoid suboccipital surgical approach. A 27-year-old male patient with recently diagnosed hypertension (on calcium channel blocker) underwent left CP angle lesion decompression. Transient episodes of bradycardia, hypotension, and bradypnea were observed from the skin incision onward, exacerbated during tumor manipulation. Most episodes subsided with cessation of the surgical stimulus while some required intervention. Postoperatively, blood pressure decreased below the pre-operative levels. Thus, trigeminocardiac reflex can occur as early as the skin incision even in a retrosigmoid approach due to stimulation of the mandibular division, when specific risk factors exist. Such episodes may serve as early warning signs for subsequent intraoperative occurrences. Brainstem compression can be a possible etiology of hypertension in young patients. It underscores the importance of considering brain-heart interactions in surgical interventions involving the CP angle.
小脑脑桥角（CP角）病变与多种脑-心相互作用相关，这可能包括在乙状窦后枕下手术入路中沿头皮切口刺激第五颅神经所引发的相互作用。一名27岁近期诊断为高血压（正在服用钙通道阻滞剂）的男性患者接受了左侧CP角病变减压手术。从皮肤切口开始就观察到心动过缓、低血压和呼吸过缓的短暂发作，在肿瘤操作期间加剧。大多数发作在手术刺激停止后缓解，而有些则需要干预。术后，血压降至术前水平以下。因此，当存在特定风险因素时，即使在乙状窦后入路中，由于下颌支受到刺激，三叉神经心脏反射最早可在皮肤切口时就出现。此类发作可能作为后续术中情况的早期预警信号。脑干受压可能是年轻患者高血压的一个潜在病因。这凸显了在涉及CP角的手术干预中考虑脑-心相互作用的重要性。
