• Husain Shakil, Alick P Wang, Dillon A Horth, Saeda S Nair, and Kesava K V Reddy.
• Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
• World Neurosurg. 2019 Feb 1; 122: 424-427.

BackgroundThe trigeminocardiac reflex is a sudden onset of bradycardia, hypotension, apnea, or gastric hypermotility in response to stimulation of the trigeminal nerve.Case DescriptionA 60-year-old female underwent a left orbitozygomatic craniotomy to debulk a large skull base epidermoid cyst compressing the brainstem and cranial nerves. Intraoperatively, retraction of the temporalis muscle consistently produced asystole. Cessation of retraction resulted in prompt return of sinus rhythm.ConclusionsOur report describes an unusual and extreme example of the trigeminocardiac reflex and explores possible etiologies. This is the third reported surgical case in which manipulation of the temporalis muscle alone was sufficient to elicit bradycardia and asystole, and the first such case within the context of neurosurgery. We emphasize the importance of surgical teams to be cognizant of such extreme examples of this reflex.Copyright © 2018 Elsevier Inc. All rights reserved.

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