title: Functional Outcome Changes in Surgery for Pituitary Adenomas After Intraoperative Occurrence of the Trigeminocardiac Reflex: First Description in a Retrospective Observational Study.
abstract: Trigeminocardiac reflex (TCR) represents now a nearly ubiquitary phenomenon in skull base surgery. Functional relevance of the intrainterventional TCR occurrence is hitherto only proven for vestibular schwannoma. In a retrospective observational study, 19 out of 338 (8%) enrolled adult patients demonstrated a TCR during transsphenoidal/transcranial surgery for pituitary adenomas. The 2 subgroups (TCR vs non-TCR) had similar patient's characteristics, risk factors, and histology. Preoperatively, there was a similar distribution of normal pituitary function in the TCR and non-TCR subgroups. In this TCR subgroup, there was a significant decrease of that normal pituitary function after operation (37%) compared to the non-TCR group (60%) (P < 0.03). The TCR subgroup therefore demonstrated a 3.15 times (95%CI 1.15-8.68) higher risk for non-normalizing of postoperative pituitary function compared with the non-TCR subgroup (P < 0.03). It is presented, for the first time, an impact of TCR on the functional hormonal outcome after pituitary surgery and strongly underline again the importance of the TCR in clinical daily practice. As a consequence, TCR should be considered as a negative prognostic factor of hormonal normalization after surgery for pituitary adenomas that should be included into routine practice.
authors.affiliation: From the Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, Canada (CT); Department of Neurosurgery, University of Erlangen-Nuremberg, Germany (NC, FA, BM), and Department of Research, University of Southampton, Southampton, UK (SN, SB).
authors.forename: T
authors.initials: T
authors.lastname: Chowdhury
authors.forename: C
authors.initials: C
authors.lastname: Nöthen
authors.forename: A
authors.initials: A
authors.lastname: Filis
authors.forename: N
authors.initials: N
authors.lastname: Sandu
authors.forename: M
authors.initials: M
authors.lastname: Buchfelder
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schaller
mesh_terms: D000236:Adenoma / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000378:metabolism / Q000503:physiopathology*; D010911:Pituitary Neoplasms / Q000601:surgery*; D059230:Reflex, Trigeminocardiac; D012189:Retrospective Studies