Summary
Object. Surgical manipulation of the fifth cranial nerve in its intra- or extracranial course may lead to bradycardia or even asystole as well as arterial hypotension, a phenomenon described as the trigemino-cardiac reflex (TCR), first described by the authors previonsly [11]. The authors report here the impact of this reflex on post-operative ipsilateral tinnitus in patients undergoing vestibular schwannoma surgery.
Methods. Thirty six patients scheduled for vestibular schwannoma surgery were studied retrospectively for parameters influencing the post-operative ipsilateral tinnitus function. According to the occurrence of intra- operative TCR the patients were divided into a TCR-subgroup and a non-TCR subgroup. There was no difference in tumour size between these subgroups.
Results. The TCR occured in 17% of the patients during vestibular schwannoma surgery and influenced the occurrence of post-operative ipsilateral tinnitus: the overall incidence of post-operative ipsilateral tinnitus was 22%. Sixty (60) percent of the patients in the TCR subgroup and 17% of those in the non-TCR subgroup expierenced ipsilateral tinnitus postoperatively. There was no correlation between tinnitus and pre- or post-operative hearing function.
Conclusion. Hypotension after intra-operative TCR is not only a negative prognostic factor for hearing preservation but also for ipsilateral tinnitus in patients undergoing vestibular schwannoma surgery. In combination with worse hearing function after intra-operative TCR, the present finding underlines the importance of the TCR during skull base surgery in relation to improved functional outcome.
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Correspondence: B. J. Schaller, Department of Neurosurgery, University of Paris, France.
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Schaller, B., Rasper, J., Filis, A. et al. Difference in functional outcome of ipsilateral tinnitus after intraoperative occurence of the trigemino-cardiac reflex in surgery for vestibular schwannomas. Acta Neurochir (Wien) 150, 157–160 (2008). https://doi.org/10.1007/s00701-007-1476-7
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DOI: https://doi.org/10.1007/s00701-007-1476-7