Trigemino‑ Cardiac Reflex and its Variations

Authors: Z. Haviarová 1;  E. Lalciková 2
Authors‘ workplace: Anatomický ústav, LF UK v Bratislave 1;  V. interná klinika LF UK a UN Bratislava 2
Published in: Cesk Slov Neurol N 2013; 76/109(4): 425-429
Category: Review Article


Oculo‑ cardiac reflex (OCR) is a well‑known phenomenon. Its variations (afferentation through the maxillar and mandibular branches of the trigeminal nerve) are not so widely known even though they have been described in the literature. Over the last decade, this „Trigemino‑ Cardiac Reflex“ (TCR) has been widely discussed by neurosurgeons and maxillo‑ facial surgeons. We describe one case of maxillo‑ cardiac variation of the TCR. This reflex deserves attention of other medical specialists as they might also be confronted with it.

Key words:
oculo-cardiac reflex – trigemino-cardiac reflex – bradycardia – hypotension


1. Abdulazim A, Stienen MN, Sadr‑ Eshkevari P, Prochnow N, Sandu N, Bohluli B et al. Trigeminocardiac reflex in neurosurgery –  current knowledge and prospects. In: Signorelli F (ed). Explicative cases of controversial issues in neurosurgery. New York: InTech 2012: 1– 18.

2. Lang S, Lanigan DT, van der Wal M. Trigeminocardiac reflexes: maxillary and mandibular variants of the oculocardiac reflex. Can J Anaesth 1991; 38(6): 757– 760.

3. Schaller B, Cornelius JF, Prabhakar H, Koerbel A, Gnanalingham K, Sandu N et al. The trigemino‑ cardiac reflex: an update of the current knowledge. J Neurosurg Anesthesiol 2009; 21(3): 187– 195.

4. Sandu N, Spiriev T, Lemaitre F, Filis A, Schaller B.Trigemino‑ Cardiac‑ Reflex‑ Examination‑ Group (T.C.R.E.G). New molecular knowledge towards the trigemino‑ cardiac reflex as a cerebral oxygen‑ conserving reflex. Scient World J 2010; 10: 811– 817.

5. Sandu N, Cornelius J, Filis A, Nöthen C, Rasper J, Kulinsky VI et al. Cerebral hemodynamic changes during the trigeminocardiac reflex: description of a new animal model protocol. Scient World J 2010; 10: 1416– 1423.

6. Gorini C, Jameson HS, Mendelowitz D. Serotonergic modulation of the trigeminocardiac reflex neurotransmission to cardiac vagal neurons in the nucleus ambiguus. J Neurophysiol 2009; 102(3): 1443– 1450.

7. Kim JY, Park JS, Baek DJ, Lee SI, Kim KT, Choe WJet al. Asystole via Trigeminocardiac Reflex during Skin Flap Elevation in a Patient Undergoing Craniotomy for Cerebral Aneurysm Clipping: a case report. Korean J Anesthesiol 2008; 54(2): 220– 224.

8. Jaiswal AK, Gupta D, Verma N, Behari S. Trigeminocardiac reflex: a cause of sudden asystole during cerebellopontine angle surgery. J Clin Neurosci 2009; 17(5): 641– 644.

9. Cho JM, Min KT, Kim EH, Oh MC, Kim SH. Sudden asystole due to trigeminocardiac reflex during trans­sphenoidal surgery for pituitary tumor. World Neurosurg 2001; 76(5): 477.e11– 477.e15.

10. Spiriev T, Tzekov C, Kondoff S, Laleva L, Sandu N, Arasho B et al. Trigemino‑ cardiac reflex during chronic subdural haematoma removal: report of chemical initiation of dural sensitization. JRSM Short Rep 2011; 2(4): 27.

11. Arakeri G, Raghuram CG, Reddy S, Arali V. Arakeri’s reflex: an alternative pathway for dento –  cardiac reflex mediated Syncope. Dental Hypotheses 2010; 1(1): 9– 16.

12. Bauer DF, Youkilis A, Schenck C, Turner CR, Thompson G. The falcine trigeminocardiac reflex: case report and review of the literature. Surg Neurol 2005; 63(2): 143– 148.

13. Yorgancilar E, Gun R, Yildirim M, Bakir S, Akkus Z,Topcu I. Determination of trigeminocardiac reflex during rhinoplasty. Int J Oral Maxillofac Surg 2012; 41(3): 389– 393.

14. Wartak SA, Mehendale RA, Lotfi A. A unique case of asystole secondary to facial injury. Case Rep Med 2012; 2012: 382605.

15. Bohluli B, Ashtiani AK, Khayampoor A, Sadr‑ Eshkevari P. Trigeminocardiac reflex: a MaxFax literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108(2): 184– 188.

16. Cornelius JF, Sadr‑ Eshkevari P, Arasho BD, Sandu N, Spiriev T, Lemaitre F et al. The trigemino‑ cardiac reflex in adults: own experience. Expert Rev Cardiovasc Ther 2010; 8(7): 895– 898.

17. Holmes WD, Finch JJ, Snell D, Sloan SB. The trigeminocardiac reflex and dermatologic surgery. Dermatol Surg 2011; 37(12): 1795– 1797.

18. Sandu N, Sadr‑ Eshkevari P, Schaller BJ. Trigemino‑ Cardiac Reflex Examination Group (TCREG). Usefulness of case reports to improve medical knowledge regarding trigemino‑ cardiac reflex in skull base surgery. J Med Case Rep 2011; 5: 149.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 4

2013 Issue 4

Most read in this issue
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account