Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, USA.
Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA.
Acta Neurochir (Wien). 2024 Jul 15;166(1):297. doi: 10.1007/s00701-024-06178-9.
The trigeminocardiac reflex (TCR) has traditionally been characterized by a sudden decrease in heart rate, asystole, or hypotension during the manipulation of the trigeminal nerve (MTN) or its branches. While this classical TCR is well-documented, there is limited literature on alternative forms of TCR, such as the development of intraoperative hypertension (HTN) or tachycardia, and the underlying pathogenesis. Furthermore, a gap exists in understanding the correlation between intraoperative blood pressure readings and postoperative outcomes, particularly regarding pain relief in patients with trigeminal neuralgia (TN). Our study aims to examine intraoperative blood pressure trends during microvascular decompression (MVD) for TN and assess their impact on postoperative outcomes.
We selected 90 patients who underwent MVD for TN treatment. Blood pressure and heart rate were recorded both preoperatively and during the procedure, specifically during the MTN period, using an arterial line. The Barrow Neurological Institute (BNI) Pain Scale was calculated for all patients both pre- and post-operatively to evaluate pain relief after surgery.
The mean age of the patients was 61.0 ± 12.35 years, with 64.4% being females. Classical TCR (hypotension) was observed in only 2.2% of patients, whereas 80% of patients developed hypertension (≥ 140/90) during MTN. The mean preoperative systolic blood pressure was 128 ± 22.25, and the mean intraoperative systolic blood pressure during MTN was 153.1 ± 20.2. An analysis of covariance, utilizing either preoperative BNI or duration of symptoms as covariate variables, revealed a statistically significant association between intraoperative HTN and postoperative BNI. A linear regression model demonstrated that intraoperative HTN following MTN significantly predicted a lower postoperative BNI score (p = 0.006).
Intraoperative HTN during MTN, an observed yet underexplored phenomenon, demonstrated a correlation with improved postoperative outcomes. Furthermore, it is recommended to conduct additional investigations into potential neurovascular conflicts in patients not manifesting intraoperative HTN following MTN. A comprehensive understanding of TCR, encompassing its various forms, is vital for optimizing surgical management. This study underscores the imperative for further research to unravel the mechanisms linking intraoperative HTN to surgical outcomes in TN patients.
三叉心反射（TCR）传统上表现为在三叉神经（MTN）或其分支的操作过程中，心率突然下降、心动过缓或低血压。虽然这种经典的 TCR 已有充分的文献记载，但关于 TCR 的其他形式，如术中高血压（HTN）或心动过速的发展，以及潜在的发病机制，文献有限。此外，对于术中血压读数与术后结果之间的相关性，特别是三叉神经痛（TN）患者的疼痛缓解，理解上存在差距。我们的研究旨在检查 TN 微血管减压术（MVD）期间的术中血压趋势，并评估其对术后结果的影响。
我们选择了 90 名接受 MVD 治疗 TN 的患者。使用动脉线在术前和手术过程中记录血压和心率，特别是在 MTN 期间。所有患者均在术前和术后使用巴罗神经研究所（BNI）疼痛量表进行疼痛评估，以评估手术后的疼痛缓解情况。
患者的平均年龄为 61.0±12.35 岁，女性占 64.4%。仅 2.2%的患者出现经典 TCR（低血压），而 80%的患者在 MTN 期间出现高血压（≥140/90）。术前收缩压平均值为 128±22.25，MTN 期间术中收缩压平均值为 153.1±20.2。使用术前 BNI 或症状持续时间作为协变量变量的协方差分析显示，术中 HTN 与术后 BNI 之间存在统计学显著关联。线性回归模型表明，MTN 后术中 HTN 显著预测术后 BNI 评分较低（p=0.006）。
MTN 期间观察到但研究不足的术中 HTN 现象与术后结果改善相关。此外，建议对 MTN 后未出现术中 HTN 的患者进行潜在的神经血管冲突的进一步研究。全面了解 TCR，包括其各种形式，对于优化手术管理至关重要。本研究强调了进一步研究的必要性，以揭示 TN 患者术中 HTN 与手术结果之间的机制联系。
