Autonomic neurosurgery: from microvascular decompression to image guided stimulation

Abstract

The paper reviews mechanisms underlying autonomic disorders, with a focus on cardiovascular dysfunction. Neurosurgical approaches are described for medically refractory hypertension and orthostatic hypotension. After review of microvascular decompression of the rostral ventrolateral medulla, stereotactic CT and MRI guided deep brain stimulation of the periaqueductal grey matter (PAG) is evaluated. Results are presented from patient studies showing reductions in blood pressure with ventral PAG stimulation and increases in blood pressure with dorsal PAG stimulation. A rationale for the treatment of autonomic disorders by neurosurgical intervention is discussed.

Effects of Deep Brain Stimulation on Autonomic Function

“…Green et al [ 25 ] determined these effects to be due to modulation of sympathetic activity, due to the presence of changes in both total peripheral resistance (TPR) and myocardial contractility [ 25 ]. Later publications, reviews, and case reports by Green et al and other groups all report similar findings in humans and in animal models [ 12 , 13 , 22 , 23 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

“…DBS has shown significant effects on hypertension and hypotension. Depending on the target in the brain, DBS can cause a decrease or increase in blood pressure, and a decrease in orthostatic hypotension [ 22 , 23 , 24 ]. What makes this variable outcome possible is precise placement of the electrodes into their targets.…”

Surgical Neurostimulation for Spinal Cord Injury

“…DBS has also been shown to affect blood pressure with dorsal central gray stimulation resulting in an increase in blood pressure and ventral central gray stimulation resulting in a decrease in blood pressure [ 136 , 137 , 138 , 139 , 140 , 141 ]. There are therefore potential avenues to treat both the orthostatic hyptension and autonomic dysreflexia seen in SCI patients.…”