The trigemino‑cardiac reflex (TCR) is a clinical phenomenon where heart rate and blood pressure suddenly fall down below 20% of the baseline during surgical procedures involving the fifth pair of trigeminal nerves. During acoustic neuroma resection, TCR often appears due to surgical operations and other mechanical stimuli around the trigeminal nerve, which is characterized in sudden bradycardia, hypotension and even cardiac arrest. In the current report, a 52‑year‑old woman underwent right acoustic neuroma resection under general anesthesia. During the surgery, bradycardia suddenly occurred when neomycin sulfate solution was used to rinse the brain before cranial closure, followed by cardiac arrest. As the surgery stopped, heart beat was recovered. The whole process was about 15 s, the patient gradually recovered after the operation was stopped. Based on the case, we discussed related factors of TCR during operation, so as to deepen the understanding of TCR.