Neurovascular Pulsatile Compression and Neurosurgical Decompression of the Rostral Ventrolateral Medulla in Medically Resistant Hypertensive Patients

Abstract

Background/Aims: In cases of severe primary hypertension not responding to conventional medical therapy, neurovascular pulsatile compression of the rostral ventrolateral medulla on the left side may be considered as an etiological factor in the hypertension. Through neurosurgical decompression, the blood pressure can be reduced in these cases, and the conventional medication can also become more effective. Methods:The authors retrospectively analysed the changes in the blood pressure and therapy of patients with or without neurosurgical decompression over a 2-year period. The 2-year data were available for 9 operated and 7 non-operated patients with neurovascular compression. The data of control examinations performed 1, 3, 6, 12 and 24 months after the intervention (or after MR-angiography in the non-operated cases) were analysed. Results: After the decompression, both the systolic and diastolic blood pressure decreased significantly and permanently in all cases, and there was an improved response to the medication. In the non-operated group, the blood pressure did not change significantly during the 2 years. Conclusion: In severe hypertension that does not respond to conventional therapy, neurosurgical decompression of the brain stem on the left side can guarantee a long-lasting blood pressure reduction and a better response to antihypertensive medication.

Effect of left-sided brain stem decompression on blood pressure and short-term cardiovascular regulation in resistant hypertension

“…In 18 cases, a successful NVD was performed, and after follow-up of 9 patients for 2 years, the BP values and the therapeutic effort were decreased compared with the preoperative period. 7 The lower plasma NE level and higher BRS values after NVD confirm that there is sympathetic overactivity in RVLM pulsatile compression. NVD confirms that C1 neurons may have an important role in the maintenance of this sympathetic overactivity.…”

Observations of Changes of Blood Pressure Before and after Neurosurgical Decompression in Hypertensive Patients with Different Types of Neurovascular Compression of Brain Stem

“…Our patients did not show any symptoms of cranial rhizopathies. In a previous work we described that 2 years after a successful NVD the BP values and the therapeutic efforts were decreased compared to the pre-operative period [23]. …”

Neurovascular compression of the medulla oblongata, case report. The rare cause of secondary hypertension

“…A betegek közül kilenc betegnél végeztek dekompressziós műtétet. A betegek mindegyikénél tartósan csökkent a vérnyomás, jobban reagáltak az antihipertenzív gyógyszerekre, míg a hét nem operált beteg esetében a vérnyomás változatlan maradt [14]. Ugyanennek a munkacsoportnak az adatai alapján sem a műtét előtti, sem a műtét utáni vérnyomásértékek nem mutattak összefüggést az NVC típusával, a gyógyszeres kezelésre nem reagáló betegeknél a dekompressziós mű-tét az NVC típusától függetlenül kedvező hatású volt [15].…”