Trigeminocardiac reflex in cerebrovascular surgery: a review and an attempt of a predictive analysis.

INTRODUCTION: Trigemino-cardiac reflex (TCR) is a well-established neurogenic reflex that is primarily observed in many neurosurgical procedures, especially skull base surgery. Few management strategies have been highlighted in the literature; however, controversies still exist related to this topic. Areas covered: The authors present for the first time the results of a multivariable analysis to predict the TCR during cerebrovascular surgery. However, such first statistical results have not yet any impact on the treatment of the TCR, as correlation is not the cause. Therefore, there is highlighted different management options in such cases providing a better understanding of TCR and associated various facts that are important for anesthesiologist as well as the surgeon. Expert commentary: The TCR can be successfully managed by the cessation of the stimulus producing the TCR. Decision support tools are needed to make static predictive analysis dynamic and useful for a single patient and to make (skull base) surgery still safer.