Ventricular Fibrillation as an Uncommon Manifestation of Trigeminocardiac Reflex during Simultaneous Surgery for Aneurysmal Clipping and Trigeminal Schwannoma Resection

Abstract

Trigeminocardiac re fl ex (TCR) from stimulation of sensory branches of trigeminal nerve during neurosurgeries may produce various types of arrhythmias, including bradycar-dia and asystole. Rarely, TCR can present with unusual manifestations such as tachyarrhythmias secondary to sympathetic stimulation. Ventricular tachycardia (VT) and fi - brillation (VF) are rare in neurosurgical patients without preexisting cardiac etiology. We report such presentation during simultaneous surgery of cerebral aneurysmal clipping and trigeminal schwannoma excision that was man-aged successfully. A 52-year-old female patient with a history of hypertension presented with headache and one episode of loss of consciousness. Her admission Glasgow Coma Scale score was E4V5M6. On radiological evaluation, she was diagnosed with subarachnoid hemorrhage (aneurysmal) from ruptured anterior communicating artery aneurysm measuring 1.1 (cid:1) 0.8cm and coexisting trigeminal schwannoma measuring 4.3 (cid:1) 4.1cm ( ► Fig.