Abstract
Transient bradycardia, hypotension, and asystole arise from activation of the trigemino-vagal reflex by direct stimulation of the trigeminal nerve or branches in the dura mater or cerebellar tentorium. We report two cases of transient asystole during surgery by activation of the trigemino-vagal reflex. In one case, a 63-year-old woman with an unruptured internal carotid artery aneurysm at the origin of the anterior choroidal artery underwent craniotomy. When a clip applied for neck clipping touched the dura mater, transient asystole occurred twice, lasting 4-5 seconds each. After immediate cessation of surgical manipulation, heart contractions recovered spontaneously. The trigemino-vagal reflex may occur in any open craniotomy surgery, and is not rare in clipping operations for supratentorial unruptured aneurysm. However, this reflex recovered without any postoperative complications following prompt cessation of surgical manipulations. (Received July 9, 2012;accepted April 2, 2014)
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