• Jin Mo Cho, Kyung Tae Min, Eui Hyun Kim, Min Chul Oh, and Sun Ho Kim.
• Department of Neurosurgery, Pituitary Tumor Clinics, Yonsei Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
• World Neurosurg. 2011 Nov 1; 76 (5): 477.e11-5.

BackgroundA 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.Case DescriptionWe 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.ConclusionsAlthough 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.Copyright © 2011 Elsevier Inc. All rights reserved.

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