Review Article

Cardiac Emergencies in Neurosurgical Patients

Table 3

Cardiac emergencies in posterior fossa surgery.

AuthorPatientProcedureCardiac rhythmCauseManagementOutcome

Harada et al. [20]69 y ♂ Craniotomy (CPA) meningioma)ST elevation, VFCoronary artery spasm secondary (vagal stimulation)Procedure abandonedNo neurological deficits
Jaiswal et al. [21]32 y ♂Retromastoid suboccipital craniotomyBradycardia, asystole, VF, AFTCR Atropine, CPR, epinephrine, amiodaroneNo neurological deficits
Usami et al. [22]3 patients [36–52 y; ♀ = 2, ♂ = 1]Temporal craniotomy (); retrosigmoid craniotomy ()Asystole ()TCR (), remifentanil
( = 3)
Atropine (); surgery interruption ()No neurological deficits
Prabhakar et al. [23]40 y ♀Retromastoid suboccipital craniotomyAsystoleTCRSurgery interruptionMild facial paresis
Schaller [24]1/28Microvascular trigeminal decompressionAsystole (33 s)TCRSurgery interruptionNo neurological deficits
Sellery [25]♀, age not specifiedChiari malformation Asystole (20 s)Brain stem manipulationAtropine, ephedrineNo neurological deficits
Raman Sharma et al. [26]60 y ♀Retromastoid suboccipital craniotomyBradycardia (recurrent), asystole (40 s × 3 times) Tumor excision
(vagal stimulation)
Interruption surgeryRight vocal cord paralysis
Schaller et al. [27]3/125 patientsCPA surgeryAsystole (<180 s)TCRSurgery interruption (), atropine ()No neurological deficits
Loewenthal
et al. [28]
53 ♀ Cerebellar meningiomaBradycardia, asystole (3 min)Coronary artery gas embolism; hypovolemiaCPR in prone positionNo neurological deficits
Isabel et al. [29]48 y ♀Right retromastoid craniectomy, Asystole (up to 45 s × many times)GVR Lidocaine, atropine; surgery interruption; transvenous pacing No neurological deficits
Nagashima et al. [30]74 y ♀Suboccipital craniotomy (vagal rootlet section)AsystoleVagal stimulationAtropineAltered sensorium for 5 days

♀ = female gender; ♂ = male gender; CPA = cerebellopontine angle; TCR = trigeminocardiac reflex; GVR = glossopharyngeal-vagal reflex; no neurological deficits = postoperative deficits not mentioned.