Recurrent trigeminocardiac reflex in percutaneous balloon compression for trigeminal neuralgia: A case report

RATIONALE: Trigeminocardiac reflex (TCR) sometimes occurs during the percutaneous balloon compression (PBC) procedure to treat trigeminal neuralgia (TN), and it manifests as transient bradycardia or sinus arrest. However, recurrent intraoperative TCR cases are rarely reported. Meanwhile, the treatment for recurrent TCR is still unclear. PATIENT CONCERNS: A 74-year-old male with a 2-year TN history could no longer tolerate the side effects of carbamazepine and came to seek PBC treatment. DIAGNOSES: Bradycardia or sinus arrest occurred repeatedly during the operation, and the heart rate (HR) rapidly returned to normal when the operation was suspended. The C-arm image showed the puncture needle entering the foramen ovale. INTERVENTIONS: First, 0.5 mg atropine was administered twice, and then 1 mL of 2% lidocaine was injected locally at the puncture site. Finally, isoproterenol was continuously pumped and dynamically adjusted to maintain the HR above 90 bpm. OUTCOMES: The use of atropine and lidocaine did not prevent the recurrence of TCR. The use of isoproterenol to maintain the HR enabled the successful completion of the operation. The patient recovered quickly after the operation and was discharged 2 days later. No complaints of discomfort were reported during the sixth-month follow-up. LESSONS: The elimination of intraoperative TCR may be difficult. Maintaining a high HR intraoperatively by continuous isoproterenol infusion is effective for preventing or mitigating the onset of TCR.