Transsphenoidal/transcranial surgery of pituitary adenomas: Prognosis-related occurence for the trigemino-cardiac reflex

Abstract

This chapter summarizes the well-known trigemino-cardiac reflex (TCR) that was fi rst introduced into skull base surgery by the senior author. We present here the prognostic factors of this brainstem reflex by the example of the transcranial/transsphenoidal operations for pituitary adenomas. A retrospective study of all patients operated on a pituitary adenoma were evaluated between 2000 and 2006. Building two subgroups with and without intraoperative occurrence of the TCR, there was seen no difference in the patients characteristics between these two subgroups. But we found a signi fi cant difference for loop diuretics and potassium-sparing diuretic favouring the TCR subgroup. In addition, there is also a signi fi cant difference for psychostimulans and morphine analogues. From the present point of knowledge it is not clear whether or not the risk pro fi le is at least dependent of the peripheral or central stimulation of the nerve and may therefore be changed for different skull base operations. So that the present risk factor are only valuable in operations for pituitary adenomas. The knowledge of the TCR is nowadays a MUST for every skull base surgeon and also for every physicians involved in the treatment of patients with skull base pathologies.