{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:32:55Z","timestamp":1769725975907,"version":"3.49.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"21","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,24]]},"abstract":"\n BACKGROUND<\/jats:title>\n Trigeminocardiac reflex (TCR) is a well-known phenomenon that causes bradycardia, hypotension, and cardiac arrest through mechanical stimulation of the trigeminal nerve distribution. Although TCR has been reported during posterior fossa surgeries, cardiac arrest during supratentorial aneurysm clipping is exceptionally rare.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n An 88-year-old woman with a ruptured internal carotid\u2013posterior communicating artery aneurysm underwent craniotomy via a pterional approach. During clip application using a slightly curved Sugita no. 65 clip inserted along the sphenoid ridge dura, an 8-second cardiac arrest occurred before clip closure. Immediate clip withdrawal resulted in spontaneous recovery of rhythm. Subsequently, a straight Sugita no. 15 clip was applied horizontally toward the suprasellar cistern to avoid dural contact, and successful clipping was achieved without cardiac arrest. Intraoperative monitoring confirmed a complete electrocardiogram and arterial pressure loss during the initial episode.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case demonstrates that TCR can occur during supratentorial aneurysm clipping through stimulation of trigeminal nerve\u2013innervated dural structures. Complications were prevented by changing the clip geometry from a curved to a straight configuration and modifying the surgical approach to avoid dural contact. Appropriate clip selection considering the spatial anatomy, trajectory control, and surrounding anatomical structures is crucial for preventing this potentially serious complication during aneurysm surgery.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25591<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25591","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:13:18Z","timestamp":1769685198000},"source":"Crossref","is-referenced-by-count":0,"title":["Transient cardiac arrest due to trigeminocardiac reflex during aneurysm clipping: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Yuto","family":"Ando","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9270-2688","authenticated-orcid":true,"given":"Takenori","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Sumitomo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuta","family":"Koketsu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikio","family":"Maruwaka","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akino","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiji","family":"Tachibana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Toyota Kosei Hospital, Toyota, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshinori","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"J Neurosurg","first-page":"215","article-title":"Trigeminocardiac reflex during surgery in the cerebellopontine angle","volume":"90","author":"Schaller","year":"1999","unstructured":"Schaller BProbst RStrebel SGratzl O.Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg. 1999;90(2):215-220."},{"issue":"6","key":"bib2","series-title":"J Neurol","first-page":"658","article-title":"Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity?","volume":"251","author":"Schaller","year":"2004","unstructured":"Schaller B.Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol. 2004;251(6):658-665."},{"issue":"1","key":"bib3","series-title":"J Neurosurg Anesthesiol","first-page":"45","article-title":"Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia","volume":"17","author":"Schaller","year":"2005","unstructured":"Schaller B.Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia. J Neurosurg Anesthesiol. 2005;17(1):45-48."},{"issue":"6","key":"bib4","series-title":"Clin Neurol Neurosurg","first-page":"468","article-title":"Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas","volume":"107","author":"Schaller","year":"2005","unstructured":"Schaller B.Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas. Clin Neurol Neurosurg. 2005;107(6):468-474."},{"issue":"12","key":"bib5","series-title":"Neurol Med Chir (Tokyo)","first-page":"805","article-title":"Combination therapy of fasudil hydrochloride and ozagrel sodium for cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"38","author":"Nakashima","year":"1998","unstructured":"Nakashima STabuchi KShimokawa SFukuyama KMineta TAbe M.Combination therapy of fasudil hydrochloride and ozagrel sodium for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 1998;38(12):805-810."},{"issue":"2","key":"bib6","series-title":"Eur J Clin Pharmacol","first-page":"131","article-title":"Systematic assessment and meta-analysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage","volume":"68","author":"Liu","year":"2012","unstructured":"Liu GJWang ZJWang YFSystematic assessment and meta-analysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage. Eur J Clin Pharmacol. 2012;68(2):131-139."},{"issue":"4","key":"bib7","series-title":"Neurol India","first-page":"375","article-title":"Management of the trigeminocardiac reflex: facts and own experience","volume":"57","author":"Arasho","year":"2009","unstructured":"Arasho BSandu NSpiriev TPrabhakar HSchaller B.Management of the trigeminocardiac reflex: facts and own experience. Neurol India. 2009;57(4):375-380."},{"issue":"7","key":"bib8","series-title":"J Neurosurg Case Lessons","first-page":"CASE21198","article-title":"Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case","volume":"2","author":"Yamada","year":"2021","unstructured":"Yamada SYano YFujita TTaneda M.Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case. J Neurosurg Case Lessons. 2021;2(7):CASE21198."},{"issue":"1","key":"bib9","series-title":"JA Clin Rep","first-page":"2","article-title":"Prevention of trigeminocardiac reflex-induced severe bradycardia during cerebral aneurysm clipping surgery by topical anesthesia of the dura surface and atropine administration: a case report","volume":"8","author":"Yoshida","year":"2022","unstructured":"Yoshida ASeki TAratani YTanioku TKawamata T.Prevention of trigeminocardiac reflex-induced severe bradycardia during cerebral aneurysm clipping surgery by topical anesthesia of the dura surface and atropine administration: a case report. JA Clin Rep. 2022;8(1):2."},{"issue":"8","key":"bib10","series-title":"Jpn J Neurosurg","first-page":"673","article-title":"Transient asystole during surgery for intracranial unruptured aneurysms caused by excitation of the trigemino-vagal reflex: two case reports","volume":"23","author":"Shibata","year":"2014","unstructured":"Shibata TSakai NTani STransient asystole during surgery for intracranial unruptured aneurysms caused by excitation of the trigemino-vagal reflex: two case reports. Jpn J Neurosurg. 2014;23(8):673-677."},{"issue":"10","key":"bib11","series-title":"No Shinkei Geka","first-page":"903","article-title":"A case of trigeminocardiac reflex in the pterional approach","volume":"40","author":"Kitabayashi","year":"2012","unstructured":"Kitabayashi MNakamura KMurata T.A case of trigeminocardiac reflex in the pterional approach. Article in Japanese. No Shinkei Geka. 2012;40(10):903-907."},{"issue":"4","key":"bib12","series-title":"Asian J Neurosurg","first-page":"787","article-title":"Cardiac arrest during temporary clipping for ruptured internal carotid artery aneurysm: a case report","volume":"19","author":"Shimizu","year":"2024","unstructured":"Shimizu TKosaka HYamamoto Y.Cardiac arrest during temporary clipping for ruptured internal carotid artery aneurysm: a case report. Asian J Neurosurg. 2024;19(4):787-790."},{"key":"bib13","series-title":"J Anat","first-page":"57","article-title":"Distribution and termination of trigeminal nerves to the cerebral arteries in monkeys","volume":"159","author":"Simons","year":"1988","unstructured":"Simons TRuskell GL.Distribution and termination of trigeminal nerves to the cerebral arteries in monkeys. J Anat. 1988;159:57-71."},{"issue":"7","key":"bib14","series-title":"Cureus","first-page":"e3079","article-title":"The tentorium cerebelli: a comprehensive review including its anatomy, embryology, and surgical techniques","volume":"10","author":"Rai","year":"2018","unstructured":"Rai RIwanaga JShokouhi GOskouian RJTubbs RS.The tentorium cerebelli: a comprehensive review including its anatomy, embryology, and surgical techniques. Cureus. 2018;10(7):e3079."},{"issue":"6","key":"bib15","series-title":"Headache","first-page":"305","article-title":"The meningeal representation in the trigeminal ganglion an experimental study in the cat","volume":"24","author":"Steiger","year":"1984","unstructured":"Steiger HJMeakin CJ.The meningeal representation in the trigeminal ganglion an experimental study in the cat. Headache. 1984;24(6):305-309."},{"issue":"4","key":"bib16","series-title":"Binocul Vis Strabismus Q","first-page":"215","article-title":"The profound augmentation of the oculocardiac reflex by fast acting opioids","volume":"19","author":"Arnold","year":"2004","unstructured":"Arnold RWJensen PAKovtoun TAMaurer SASchultz JA.The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q. 2004;19(4):215-222."},{"issue":"2","key":"bib1","series-title":"J Neurosurg","first-page":"215","article-title":"Trigeminocardiac reflex during surgery in the cerebellopontine angle","volume":"90","author":"Schaller","year":"1999","unstructured":"Schaller BProbst RStrebel SGratzl O.Trigeminocardiac reflex during surgery in the cerebellopontine angle. J Neurosurg. 1999;90(2):215-220."},{"issue":"6","key":"bib2","series-title":"J Neurol","first-page":"658","article-title":"Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity?","volume":"251","author":"Schaller","year":"2004","unstructured":"Schaller B.Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol. 2004;251(6):658-665."},{"issue":"1","key":"bib3","series-title":"J Neurosurg Anesthesiol","first-page":"45","article-title":"Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia","volume":"17","author":"Schaller","year":"2005","unstructured":"Schaller B.Trigemino-cardiac reflex during microvascular trigeminal decompression in cases of trigeminal neuralgia. J Neurosurg Anesthesiol. 2005;17(1):45-48."},{"issue":"6","key":"bib4","series-title":"Clin Neurol Neurosurg","first-page":"468","article-title":"Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas","volume":"107","author":"Schaller","year":"2005","unstructured":"Schaller B.Trigemino-cardiac reflex during transsphenoidal surgery for pituitary adenomas. Clin Neurol Neurosurg. 2005;107(6):468-474."},{"issue":"12","key":"bib5","series-title":"Neurol Med Chir (Tokyo)","first-page":"805","article-title":"Combination therapy of fasudil hydrochloride and ozagrel sodium for cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"38","author":"Nakashima","year":"1998","unstructured":"Nakashima STabuchi KShimokawa SFukuyama KMineta TAbe M.Combination therapy of fasudil hydrochloride and ozagrel sodium for cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Neurol Med Chir (Tokyo). 1998;38(12):805-810."},{"issue":"2","key":"bib6","series-title":"Eur J Clin Pharmacol","first-page":"131","article-title":"Systematic assessment and meta-analysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage","volume":"68","author":"Liu","year":"2012","unstructured":"Liu GJWang ZJWang YFSystematic assessment and meta-analysis of the efficacy and safety of fasudil in the treatment of cerebral vasospasm in patients with subarachnoid hemorrhage. Eur J Clin Pharmacol. 2012;68(2):131-139."},{"issue":"4","key":"bib7","series-title":"Neurol India","first-page":"375","article-title":"Management of the trigeminocardiac reflex: facts and own experience","volume":"57","author":"Arasho","year":"2009","unstructured":"Arasho BSandu NSpiriev TPrabhakar HSchaller B.Management of the trigeminocardiac reflex: facts and own experience. Neurol India. 2009;57(4):375-380."},{"issue":"7","key":"bib8","series-title":"J Neurosurg Case Lessons","first-page":"CASE21198","article-title":"Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case","volume":"2","author":"Yamada","year":"2021","unstructured":"Yamada SYano YFujita TTaneda M.Efficacy of transcutaneous cardiac pacing for transient asystole caused by trigeminocardiac reflex: illustrative case. J Neurosurg Case Lessons. 2021;2(7):CASE21198."},{"issue":"1","key":"bib9","series-title":"JA Clin Rep","first-page":"2","article-title":"Prevention of trigeminocardiac reflex-induced severe bradycardia during cerebral aneurysm clipping surgery by topical anesthesia of the dura surface and atropine administration: a case report","volume":"8","author":"Yoshida","year":"2022","unstructured":"Yoshida ASeki TAratani YTanioku TKawamata T.Prevention of trigeminocardiac reflex-induced severe bradycardia during cerebral aneurysm clipping surgery by topical anesthesia of the dura surface and atropine administration: a case report. JA Clin Rep. 2022;8(1):2."},{"issue":"8","key":"bib10","series-title":"Jpn J Neurosurg","first-page":"673","article-title":"Transient asystole during surgery for intracranial unruptured aneurysms caused by excitation of the trigemino-vagal reflex: two case reports","volume":"23","author":"Shibata","year":"2014","unstructured":"Shibata TSakai NTani STransient asystole during surgery for intracranial unruptured aneurysms caused by excitation of the trigemino-vagal reflex: two case reports. Jpn J Neurosurg. 2014;23(8):673-677."},{"issue":"10","key":"bib11","series-title":"No Shinkei Geka","first-page":"903","article-title":"A case of trigeminocardiac reflex in the pterional approach","volume":"40","author":"Kitabayashi","year":"2012","unstructured":"Kitabayashi MNakamura KMurata T.A case of trigeminocardiac reflex in the pterional approach. Article in Japanese. No Shinkei Geka. 2012;40(10):903-907."},{"issue":"4","key":"bib12","series-title":"Asian J Neurosurg","first-page":"787","article-title":"Cardiac arrest during temporary clipping for ruptured internal carotid artery aneurysm: a case report","volume":"19","author":"Shimizu","year":"2024","unstructured":"Shimizu TKosaka HYamamoto Y.Cardiac arrest during temporary clipping for ruptured internal carotid artery aneurysm: a case report. Asian J Neurosurg. 2024;19(4):787-790."},{"key":"bib13","series-title":"J Anat","first-page":"57","article-title":"Distribution and termination of trigeminal nerves to the cerebral arteries in monkeys","volume":"159","author":"Simons","year":"1988","unstructured":"Simons TRuskell GL.Distribution and termination of trigeminal nerves to the cerebral arteries in monkeys. J Anat. 1988;159:57-71."},{"issue":"7","key":"bib14","series-title":"Cureus","first-page":"e3079","article-title":"The tentorium cerebelli: a comprehensive review including its anatomy, embryology, and surgical techniques","volume":"10","author":"Rai","year":"2018","unstructured":"Rai RIwanaga JShokouhi GOskouian RJTubbs RS.The tentorium cerebelli: a comprehensive review including its anatomy, embryology, and surgical techniques. Cureus. 2018;10(7):e3079."},{"issue":"6","key":"bib15","series-title":"Headache","first-page":"305","article-title":"The meningeal representation in the trigeminal ganglion an experimental study in the cat","volume":"24","author":"Steiger","year":"1984","unstructured":"Steiger HJMeakin CJ.The meningeal representation in the trigeminal ganglion an experimental study in the cat. Headache. 1984;24(6):305-309."},{"issue":"4","key":"bib16","series-title":"Binocul Vis Strabismus Q","first-page":"215","article-title":"The profound augmentation of the oculocardiac reflex by fast acting opioids","volume":"19","author":"Arnold","year":"2004","unstructured":"Arnold RWJensen PAKovtoun TAMaurer SASchultz JA.The profound augmentation of the oculocardiac reflex by fast acting opioids. Binocul Vis Strabismus Q. 2004;19(4):215-222."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/21\/article-CASE25591.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/21\/article-CASE25591.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/21\/article-CASE25591.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:13:18Z","timestamp":1769685198000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/21\/article-CASE25591.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":32,"journal-issue":{"issue":"21"},"URL":"https:\/\/doi.org\/10.3171\/case25591","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}