title: Sudden asystole due to trigeminocardiac reflex during transsphenoidal surgery for pituitary tumor.
abstract: BACKGROUND
  A sudden attack of an asystolic phenomenon is an extremely rare event during transsphenoidal surgery (TSS). It may be caused by an extreme type of trigeminocardiac reflex (TCR) during the manipulation of the trigeminal nerve or its innervated structures.
  
  
  METHODS
  We report two cases of sudden asystole and a case of severe bradycardia due to TCR during TSS. All patients were managed successfully by cessation of the surgical manipulation or with the injection of an anticholinergic agent.
  
  
  CONCLUSIONS
  Although TCR occurs rarely and usually is self-limiting, surgeons should be cautious of its occurrence, especially when manipulating the cavernous sinus during TSS. This allows the early detection and appropriate treatment of this manifestation. Stopping the surgical procedure as soon as TCR occurs is likely to normalize the vital parameters. In addition, if further manipulations are inevitable, the administration of anticholinergic medication should be considered cautiously to improve surgical outcomes.
authors.affiliation: Department of Neurosurgery, Pituitary Tumor Clinics, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Cho
authors.forename: Kyung Tae
authors.initials: KT
authors.lastname: Min
authors.forename: Eui Hyun
authors.initials: EH
authors.lastname: Kim
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Oh
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects* / Q000379:methods; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D012021:Reflex, Abnormal / Q000187:drug effects / Q000502:physiology*; D013100:Sphenoid Bone / Q000601:surgery; D061221:Trigeminal Nerve Injuries / Q000150:complications / Q000175:diagnosis*