title: Central trigeminocardiac reflex in pediatric neurosurgery: a case report and review of the literature.
abstract: BACKGROUND
  Trigeminocardiac reflex is a well-known phenomenon in neurosurgery, craniofacial surgery, ophthalmology and interventional neuroradiology. Even though the trigeminocardiac reflex has become an important factor in skull base surgery and neurosurgery, the central form of trigeminocardiac reflex has only been described in adult subpopulations until now.
  
  
  METHODS
  We present a clear form of repetitive trigeminocardiac reflex expressed during revision surgery of a giant (110×61mm) right temporoparietal meningioma in an 18-month-old male Caucasian patient. After cessation of the surgical stimulus, his heart rate and mean arterial blood pressure returned to normal physiological levels. The further follow-up was uneventful.
  
  
  CONCLUSIONS
  Our case demonstrates that the central trigeminocardiac reflex also exists in pediatric patients, especially if manipulating trigeminal innervated structures or around the nerve itself. Whether the incidence and the behavior of the trigeminocardiac reflex is similar in pediatric neurosurgery compared with adult patients has to be shown in further studies.
authors.affiliation: Department of Neurosurgery, Tokuda Hospital Sofia, 51b Nikola Vaptsarov Boulevard, Sofia, 1407, Bulgaria. spiriev@gmail.com.
authors.forename: Toma
authors.initials: T
authors.lastname: Spiriev
authors.forename: Christo
authors.initials: C
authors.lastname: Tzekov
authors.forename: Lili
authors.initials: L
authors.lastname: Laleva
authors.forename: Christina
authors.initials: C
authors.lastname: Kostadinova
authors.forename: Slavomir
authors.initials: S
authors.lastname: Kondoff
authors.forename: Nora
authors.initials: N
authors.lastname: Sandu
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaller