Association of Intraoperative Trigeminal Cardiac Reflex With Postoperative Myocardial Injury in Patients Undergoing Skull Base Tumor Surgery: A Prospective Cohort Study

Background: The association between intraoperative trigemino-cardiac reflex (TCR) and postoperative myocardial injury in patients undergoing skull base tumor resection remains unclear. Methods: This single-center prospective observational study enrolled patients undergoing elective skull base tumor resection between April 2023 and September 2024. The primary outcome was postoperative myocardial injury, defined as a cardiac troponin I level >16 ng/L within 24 hours after surgery. Patients were categorized into TCR and non-TCR groups. Logistic regression analyses were performed to explore factors associated with intraoperative TCR and postoperative myocardial injury. Results: Among 476 included patients, intraoperative TCR occurred in 27.9%, and postoperative myocardial injury occurred in 4.83%. Patients experiencing TCR had a higher rate of myocardial injury (8.3% vs. 3.5%, P =0.029). Multivariable analysis suggested that brainstem compression (adjusted OR=1.86; 95% CI: 1.19-2.91; P =0.007) and larger tumor diameter (adjusted OR=1.04; 95% CI: 1.02-1.07; P <0.001) independently associated with intraoperative TCR. TCR (adjusted OR=2.70; 95% CI: 1.12-6.53; P =0.028), older age (adjusted OR=1.06; 95% CI: 1.02-1.10; P =0.003), lower BMI (adjusted OR=0.80; 95% CI: 0.70-0.93; P =0.003), and tumor recurrence (adjusted OR=4.07; 95% CI: 1.43-11.57; P =0.009) were associated with postoperative myocardial injury after adjusting for selected confounders. Conclusion: Postoperative myocardial injury occurred in 4.83% of skull base tumor surgery patients. Intraoperative TCR increased the risk of this injury, though the link may relate to surgical complexity and patient characteristics. TCR may therefore serve as a potential clinical marker of patients at elevated perioperative cardiovascular risk rather than a direct causal mechanism.