Hypoxic brain damage caused by peripheral trigerminocardiac reflex after surgery of pituitary adenoma via transsphenoidal approach

Transsphenoidal approach (TSA) for the lesion of the sellar area is well-established technique. Trigerminocardiac reflex (TCR) occurs during skull base surgery and is known to be self-limiting. We present a case of a 47-year-old woman who underwent second operation of pituitary adenoma using TSA. During operation, there was a decrease of mean arterial blood pressure from 106 mmHg to 82 mmHg, and an accompanying decrease of the heart rate from 68 beats/min to 40 beats/min, which was treated with 0.25mg atropine. After the operation, she developed repeated seizure attacks. Computed tomography findings suggested hypoxic brain damage and TCR was suspected as the cause.