Pterional approachの際に生じたtrigeminocardiac reflexの1例

A Case of Trigeminocardiac Reflex in the Pterional Approach

Ⅰ．はじめに

　術中に心静止を来す例はときにあるが，短時間の一時的な心静止の場合，その原因が判明しないまま手術が続行または中止されることがある．今回われわれはpterional approachを行う際の前頭側頭開頭において，硬膜操作時に限り3回にわたり心静止を来した症例を経験した．その再現性と解剖学的特徴からtrigeminocardiac reflex（TCR）が心静止の原因であると判明した．TCRは後頭蓋窩手術での報告が散見されるが，pterional approachでの報告はない．TCRについて述べるとともに，本症例での発生事由について考察する．

　Trigeminocardiac reflex (TCR) is a type of vasovagal reflex which happens in stimulation of the trigeminal nerve. We present a case of TCR in the pterional approach for clipping of an unruptured anterior communicating artery (Acom) aneurysm. A 69-year-old female was evaluated because of syncope. MRI showed incidentally Acom aneurysm. During the operation for clipping this aneurysm, only when we manipulated the dura attached to the sphenoid ridge, a total of three times, asystole appeared temporarily. In this case, a branch of the trigeminal nerve accompanying the middle meningeal artery was stimulated, then TCR may have been induced, leading to asystole. Furthermore, it seems that remifentanil used for anesthesia is related to TCR.