Trigemino-cardiac reflex, during Onyx intra-arterial infusion using dimethyl sulfoxide via middle meningeal artery
Introduction: The indications for endovascular treatment of dural arteriovenous fistulas (dAVFs) in the cerebral vascular system are expanding. Currently, embolization of the feeding artery of a dAVF using Onyx has been confirmed as effective method. However, some cautions are required regarding neurological adverse events associated with the organic solvent used in Onyx treatment.
Case: A 31-year-old man diagnosed with a hemorrhagic dAVF at the transverse-sigmoid sinus junction. During the endovascular therapy involving the feeder artery embolization with Onyx, heart rate of the patient was decreased due to trigemino-cardiac reflux.
Discussion: Dimethyl sulfoxide (DMSO) was used as the solvent for Onyx. In the present case, Onyx was injected intra-arterially into the middle meningeal artery near the foramen spinosum. The exposure of DMSO toward the meningeal branch of trigeminal nerve ought to trigger the bradycardia response.
Key word: trigemino-cardiac reflex, Onyx, DMSO, MMA, foramen spinosum
